Method for operating surgical instrument systems

ABSTRACT

A method for adjusting the operation of a surgical instrument using machine learning in a surgical suite is disclosed.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application claiming priority under35 U.S.C. § 120 to U.S. patent application Ser. No. 16/234,707, entitledMETHOD FOR OPERATING SURGICAL INSTRUMENT SYSTEMS, filed Dec. 28, 2018,now U.S. Patent Application Publication No. 2019/0206565, which claimsthe benefit of U.S. Provisional Patent Application Ser. No. 62/785,415,entitled SURGICAL INSTRUMENT SYSTEMS, filed Dec. 27, 2018, of U.S.Provisional Patent Application Ser. No. 62/778,571, entitled SURGICALINSTRUMENT SYSTEMS, filed Dec. 12, 2018, of U.S. Provisional PatentApplication Ser. No. 62/778,572, entitled SURGICAL INSTRUMENT SYSTEMS,filed Dec. 12, 2018, of U.S. Provisional Patent Application Ser. No.62/778,573, entitled SURGICAL INSTRUMENT SYSTEMS, filed Dec. 12, 2018,of U.S. Provisional Patent Application Ser. No. 62/750,529, entitledMETHOD FOR OPERATING A POWERED ARTICULATING MULTI-CLIP APPLIER, filedOct. 25, 2018, of U.S. Provisional Patent Application Ser. No.62/750,539, entitled SURGICAL CLIP APPLIER, filed Oct. 25, 2018, of U.S.Provisional Patent Application Ser. No. 62/750,555, entitled SURGICALCLIP APPLIER, filed Oct. 25, 2018, of U.S. Provisional PatentApplication Ser. No. 62/659,900, entitled METHOD OF HUB COMMUNICATION,filed Apr. 19, 2018, of U.S. Provisional Patent Application Ser. No.62/665,128, entitled MODULAR SURGICAL INSTRUMENTS, filed May 1, 2018, ofU.S. Provisional Patent Application Ser. No. 62/665,129, entitledSURGICAL SUTURING SYSTEMS, filed May 1, 2018, of U.S. Provisional PatentApplication Ser. No. 62/665,134, entitled SURGICAL CLIP APPLIER, filedMay 1, 2018, of U.S. Provisional Patent Application Ser. No. 62/665,139,entitled SURGICAL INSTRUMENTS COMPRISING CONTROL SYSTEMS, filed May 1,2018, of U.S. Provisional Patent Application Ser. No. 62/665,177,entitled SURGICAL INSTRUMENTS COMPRISING HANDLE ARRANGEMENTS, filed May1, 2018, of U.S. Provisional Patent Application Ser. No. 62/665,192,entitled SURGICAL DISSECTORS, filed May 1, 2018, of U.S. ProvisionalPatent Application Ser. No. 62/649,291, entitled USE OF LASER LIGHT ANDRED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF BACK SCATTEREDLIGHT, filed Mar. 28, 2018, of U.S. Provisional Patent Application Ser.No. 62/649,294, entitled DATA STRIPPING METHOD TO INTERROGATE PATIENTRECORDS AND CREATE ANONYMIZED RECORD, filed Mar. 28, 2018, of U.S.Provisional Patent Application Ser. No. 62/649,296, entitled ADAPTIVECONTROL PROGRAM UPDATES FOR SURGICAL DEVICES, filed Mar. 28, 2018, ofU.S. Provisional Patent Application Ser. No. 62/649,300, entitledSURGICAL HUB SITUATIONAL AWARENESS, filed Mar. 28, 2018, of U.S.Provisional Patent Application Ser. No. 62/649,302, entitled INTERACTIVESURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES, filed Mar.28, 2018, of U.S. Provisional Patent Application Ser. No. 62/649,307,entitled AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICALPLATFORMS, filed Mar. 28, 2018, of U.S. Provisional Patent ApplicationSer. No. 62/649,309, entitled SURGICAL HUB SPATIAL AWARENESS TODETERMINE DEVICES IN OPERATING THEATER, filed Mar. 28, 2018, of U.S.Provisional Patent Application Ser. No. 62/649,310, entitled COMPUTERIMPLEMENTED INTERACTIVE SURGICAL SYSTEMS, filed Mar. 28, 2018, of U.S.Provisional Patent Application Ser. No. 62/649,313, entitled CLOUDINTERFACE FOR COUPLED SURGICAL DEVICES, filed Mar. 28, 2018, of U.S.Provisional Patent Application Ser. No. 62/649,315, entitled DATAHANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK, filed Mar. 28,2018, of U.S. Provisional Patent Application Ser. No. 62/649,320,entitled DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS, filedMar. 28, 2018, of U.S. Provisional Patent Application Ser. No.62/649,323, entitled SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICALPLATFORMS, filed Mar. 28, 2018, of U.S. Provisional Patent ApplicationSer. No. 62/649,327, entitled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITYAND AUTHENTICATION TRENDS AND REACTIVE MEASURES, filed Mar. 28, 2018,and of U.S. Provisional Patent Application Ser. No. 62/649,333, entitledCLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO AUSER, filed Mar. 28, 2018, of U.S. Provisional Patent Application Ser.No. 62/611,339, entitled ROBOT ASSISTED SURGICAL PLATFORM, filed Dec.28, 2017, of U.S. Provisional Patent Application Ser. No. 62/611,340,entitled CLOUD-BASED MEDICAL ANALYTICS, filed Dec. 28, 2017, and of U.S.Provisional Patent Application Ser. No. 62/611,341, entitled INTERACTIVESURGICAL PLATFORM, filed Dec. 28, 2017, the disclosures of which areincorporated by reference herein in their entireties.

BACKGROUND

The present disclosure relates to surgical systems and, in variousarrangements, to grasping instruments that are designed to grasp thetissue of a patient, dissecting instruments configured to manipulate thetissue of a patient, clip appliers configured to clip the tissue of apatient, and suturing instruments configured to suture the tissue of apatient, among others.

BRIEF DESCRIPTION OF THE DRAWINGS

Various features of the embodiments described herein, together withadvantages thereof, may be understood in accordance with the followingdescription taken in conjunction with the accompanying drawings asfollows:

FIG. 1 is a block diagram of a computer-implemented interactive surgicalsystem, in accordance with at least one aspect of the presentdisclosure;

FIG. 2 is a surgical system being used to perform a surgical procedurein an operating room, in accordance with at least one aspect of thepresent disclosure;

FIG. 3 is a surgical hub paired with a visualization system, a roboticsystem, and an intelligent instrument, in accordance with at least oneaspect of the present disclosure;

FIG. 4 is a partial perspective view of a surgical hub enclosure, and ofa combo generator module slidably receivable in a drawer of the surgicalhub enclosure, in accordance with at least one aspect of the presentdisclosure;

FIG. 5 is a perspective view of a combo generator module with bipolar,ultrasonic, and monopolar contacts and a smoke evacuation component, inaccordance with at least one aspect of the present disclosure;

FIG. 6 illustrates individual power bus attachments for a plurality oflateral docking ports of a lateral modular housing configured to receivea plurality of modules, in accordance with at least one aspect of thepresent disclosure;

FIG. 7 illustrates a vertical modular housing configured to receive aplurality of modules, in accordance with at least one aspect of thepresent disclosure;

FIG. 8 illustrates a surgical data network comprising a modularcommunication hub configured to connect modular devices located in oneor more operating theaters of a healthcare facility, or any room in ahealthcare facility specially equipped for surgical operations, to thecloud, in accordance with at least one aspect of the present disclosure;

FIG. 9 illustrates a computer-implemented interactive surgical system,in accordance with at least one aspect of the present disclosure;

FIG. 10 illustrates a surgical hub comprising a plurality of modulescoupled to the modular control tower, in accordance with at least oneaspect of the present disclosure;

FIG. 11 illustrates one aspect of a Universal Serial Bus (USB) networkhub device, in accordance with at least one aspect of the presentdisclosure;

FIG. 12 illustrates a logic diagram of a control system of a surgicalinstrument or tool, in accordance with at least one aspect of thepresent disclosure;

FIG. 13 illustrates a control circuit configured to control aspects ofthe surgical instrument or tool, in accordance with at least one aspectof the present disclosure;

FIG. 14 illustrates a combinational logic circuit configured to controlaspects of the surgical instrument or tool, in accordance with at leastone aspect of the present disclosure;

FIG. 15 illustrates a sequential logic circuit configured to controlaspects of the surgical instrument or tool, in accordance with at leastone aspect of the present disclosure;

FIG. 16 illustrates a surgical instrument or tool comprising a pluralityof motors which can be activated to perform various functions, inaccordance with at least one aspect of the present disclosure;

FIG. 17 is a schematic diagram of a robotic surgical instrumentconfigured to operate a surgical tool described herein, in accordancewith at least one aspect of the present disclosure;

FIG. 18 illustrates a block diagram of a surgical instrument programmedto control the distal translation of a displacement member, inaccordance with at least one aspect of the present disclosure;

FIG. 19 is a schematic diagram of a surgical instrument configured tocontrol various functions, in accordance with at least one aspect of thepresent disclosure;

FIG. 20 is a simplified block diagram of a generator configured toprovide inductorless tuning, among other benefits, in accordance with atleast one aspect of the present disclosure;

FIG. 21 illustrates an example of a generator, which is one form of thegenerator of FIG. 20 , in accordance with at least one aspect of thepresent disclosure;

FIG. 22 illustrates a combination generator, in accordance with at leastone aspect of the present disclosure;

FIG. 23 illustrates a method of capturing data from a combinationgenerator and communicating the captured generator data to a cloud-basedsystem, in accordance with at least one aspect of the presentdisclosure;

FIG. 24 illustrates a data packet of combination generator data, inaccordance with at least one aspect of the present disclosure;

FIG. 25 illustrates an encryption algorithm, in accordance with at leastone aspect of the present disclosure;

FIG. 26 illustrates another encryption algorithm, in accordance with atleast one aspect of the present disclosure;

FIG. 27 illustrates yet another encryption algorithm, in accordance withat least one aspect of the present disclosure;

FIG. 28 illustrates a high-level representation of a datagram, inaccordance with at least one aspect of the present disclosure;

FIG. 29 illustrates a more detailed representation of the datagram ofFIG. 28 , in accordance with at least one aspect of the presentdisclosure;

FIG. 30 illustrates another representation of the datagram of FIG. 28 ,in accordance with at least one aspect of the present disclosure;

FIG. 31 illustrates a method of identifying surgical data associatedwith a failure event and communicating the identified surgical data to acloud-based system on a prioritized basis, in accordance with at leastone aspect of the present disclosure;

FIG. 32 illustrates yet another representation of the datagram of FIG.28 , in accordance with at least one aspect of the present disclosure;

FIG. 33 illustrates a partial artificial timeline of a surgicalprocedure performed in an operating room via a surgical system, inaccordance with at least one aspect of the present disclosure;

FIG. 34 illustrates ultrasonic pinging of an operating room wall todetermine a distance between a surgical hub and the operating room wall,in accordance with at least one aspect of the present disclosure;

FIG. 35 is a logic flow diagram of a process depicting a control programor a logic configuration for surgical hub pairing with surgical devicesof a surgical system that are located within the bounds of an operatingroom, in accordance with at least one aspect of the present disclosure;

FIG. 36 is a logic flow diagram of a process depicting a control programor a logic configuration for selectively forming and severingconnections between devices of a surgical system, in accordance with atleast one aspect of the present disclosure;

FIG. 37 is a logic flow diagram of a process depicting a control programor a logic configuration for selectively reevaluating the bounds of anoperating room after detecting a new device, in accordance with at leastone aspect of the present disclosure;

FIG. 38 is a logic flow diagram of a process depicting a control programor a logic configuration for selectively reevaluating the bounds of anoperating room after disconnection of a paired device, in accordancewith at least one aspect of the present disclosure;

FIG. 39 is a logic flow diagram of a process depicting a control programor a logic configuration for reevaluating the bounds of an operatingroom by a surgical hub after detecting a change in the position of thesurgical hub, in accordance with at least one aspect of the presentdisclosure;

FIG. 40 is a logic flow diagram of a process depicting a control programor a logic configuration for selectively forming connections betweendevices of a surgical system, in accordance with at least one aspect ofthe present disclosure;

FIG. 41 is a logic flow diagram of a process depicting a control programor a logic configuration for selectively forming and severingconnections between devices of a surgical system, in accordance with atleast one aspect of the present disclosure;

FIG. 42 illustrates a surgical hub pairing a first device and a seconddevice of a surgical system in an operating room, in accordance with atleast one aspect of the present disclosure;

FIG. 43 illustrates a surgical hub unpairing a first device and a seconddevice of a surgical system in an operating room, and pairing the firstdevice with a third device in the operating room, in accordance with atleast one aspect of the present disclosure;

FIG. 44 is a logic flow diagram of a process depicting a control programor a logic configuration for forming an severing connections betweendevices of a surgical system in an operating room during a surgicalprocedure based on progression of the steps of the surgical procedure,in accordance with at least one aspect of the present disclosure;

FIG. 45 is a logic flow diagram of a process depicting a control programor a logic configuration for overlaying information derived from one ormore still frames of a livestream of a remote surgical site onto thelivestream, in accordance with at least one aspect of the presentdisclosure;

FIG. 46 is a logic flow diagram of a process depicting a control programor a logic configuration for differentiating among surgical steps of asurgical procedure, in accordance with at least one aspect of thepresent disclosure;

FIG. 47 is a logic flow diagram of a process 3230 depicting a controlprogram or a logic configuration for differentiating among surgicalsteps of a surgical procedure, in accordance with at least one aspect ofthe present disclosure;

FIG. 48 is a logic flow diagram of a process 3240 depicting a controlprogram or a logic configuration for identifying a staple cartridge frominformation derived from one or more still frames of staples deployedfrom the staple cartridge into tissue, in accordance with at least oneaspect of the present disclosure;

FIG. 49 is a partial view of a surgical system in an operating room, thesurgical system including a surgical hub that has an imaging module incommunication with an imaging device at a remote surgical site, inaccordance with at least one aspect of the present disclosure;

FIG. 50 illustrates a partial view of stapled tissue that received afirst staple firing and a second staple firing arranged end-to-end, inaccordance with at least one aspect of the present disclosure;

FIG. 51 illustrates three rows of staples deployed on one side of atissue stapled and cut by a surgical stapler, in accordance with atleast one aspect of the present disclosure;

FIG. 52 illustrates a non-anodized staple and an anodized staple, inaccordance with at least one aspect of the present disclosure;

FIG. 53 is a logic flow diagram of a process depicting a control programor a logic configuration for coordinating a control arrangement betweensurgical hubs, in accordance with at least one aspect of the presentdisclosure;

FIG. 54 illustrates an interaction between two surgical hubs in anoperating room, in accordance with at least one aspect of the presentdisclosure;

FIG. 55 is a logic flow diagram of a process depicting a control programor a logic configuration for coordinating a control arrangement betweensurgical hubs, in accordance with at least one aspect of the presentdisclosure;

FIG. 56 illustrates an interaction between two surgical hubs indifferent operating rooms (“OR1” and “OR3”), in accordance with at leastone aspect of the present disclosure;

FIG. 57 illustrates a secondary display in an operating room (“OR3”)showing a surgical site in a colorectal procedure, in accordance with atleast one aspect of the present disclosure;

FIG. 58 illustrates a personal interface or tablet in OR1 displaying thesurgical site of OR3, in accordance with at least one aspect of thepresent disclosure;

FIG. 59 illustrates an expanded view of the surgical site of OR3displayed on a primary display of OR1, in accordance with at least oneaspect of the present disclosure;

FIG. 60 illustrates a personal interface or tablet displaying a layoutof OR1 that shows available displays, in accordance with at least oneaspect of the present disclosure;

FIG. 61 illustrates a recommendation of a transection location of asurgical site of OR3 made by a surgical operator in OR1 via a personalinterface or tablet in OR1, in accordance with at least one aspect ofthe present disclosure;

FIG. 62 is a diagram illustrating a technique for interacting with apatient Electronic Medical Record (EMR) database, in accordance with atleast one aspect of the present disclosure;

FIG. 63 illustrates a process of anonymizing a surgical procedure bysubstituting an artificial time measure for a real time clock for allinformation stored internally within the instrument, robot, surgicalhub, and/or hospital computer equipment, in accordance with at least oneaspect of the present disclosure;

FIG. 64 illustrates ultrasonic pinging of an operating room wall todetermine a distance between a surgical hub and the operating room wall,in accordance with at least one aspect of the present disclosure;

FIG. 65 illustrates a diagram depicting the process of importing patientdata stored in an Electronic Medical Record (EMR) database, strippingthe patient data, and identifying smart device implications, inaccordance with at least one aspect of the present disclosure;

FIG. 66 illustrates the application of cloud based analytics to redactedand stripped patient data and independent data pairs, in accordance withat least one aspect of the present disclosure;

FIG. 67 is a logic flow diagram of a process depicting a control programor a logic configuration for associating patient data sets from firstand second sources of data, in accordance with at least one aspect ofthe present disclosure;

FIG. 68 is a logic flow diagram of a process depicting a control programor a logic configuration for stripping data to extract relevant portionsof the data to configure and operate the surgical hub and modules (e.g.,instruments) coupled to the surgical hub, in accordance with at leastone aspect of the present disclosure;

FIG. 69 illustrates a self-describing data packet comprisingself-describing data, in accordance with at least one aspect of thepresent disclosure;

FIG. 70 is a logic flow diagram of a process depicting a control programor a logic configuration for using data packets comprisingself-describing data, in accordance with at least one aspect of thepresent disclosure;

FIG. 71 is a logic flow diagram of a process depicting a control programor a logic configuration for using data packets comprisingself-describing data, in accordance with at least one aspect of thepresent disclosure;

FIG. 72 is a diagram of a tumor embedded in the right superior posteriorlobe of the right lung, in accordance with at least one aspect of thepresent disclosure;

FIG. 73 is a diagram of a lung tumor resection surgical procedureincluding four separate firings of a surgical stapler to seal and cutbronchial vessels exposed in the fissure leading to and from the upperand lower lobes of the right lung shown in FIG. 72 , in accordance withat least one aspect of the present disclosure;

FIG. 74 is a graphical illustration of a force-to-close (FTC) versustime curve and a force-to-fire (FTF) versus time curve characterizingthe first firing of device 002 as shown in FIG. 72 , in accordance withat least one aspect of the present disclosure;

FIG. 75 is a diagram of a staple line visualization laser Doppler toevaluate the integrity of staple line seals by monitoring bleeding of avessel after a firing of a surgical stapler, in accordance with at leastone aspect of the present disclosure;

FIG. 76 illustrates a paired data set grouped by surgery, in accordancewith at least one aspect of the present disclosure;

FIG. 77 is a diagram of the right lung;

FIG. 78 is a diagram of the bronchial tree including the trachea andbronchi of the lung;

FIG. 79 is a logic flow diagram of a process depicting a control programor a logic configuration for storing paired anonymous data sets groupedby surgery, in accordance with at least one aspect of the presentdisclosure;

FIG. 80 is a logic flow diagram of a process depicting a control programor a logic configuration for determining rate, frequency, and type ofdata to transfer to a remote cloud-based analytics network, inaccordance with at least one aspect of the present disclosure;

FIG. 81 illustrates a diagram of a situationally aware surgical system,in accordance with at least one aspect of the present disclosure;

FIG. 82A illustrates a logic flow diagram of a process for controlling amodular device according to contextual information derived from receiveddata, in accordance with at least one aspect of the present disclosure;

FIG. 82B illustrates a logic flow diagram of a process for controlling asecond modular device according to contextual information derived fromperioperative data received from a first modular device, in accordancewith at least one aspect of the present disclosure;

FIG. 82C illustrates a logic flow diagram of a process for controlling asecond modular device according to contextual information derived fromperioperative data received from a first modular device and the secondmodular device, in accordance with at least one aspect of the presentdisclosure;

FIG. 82D illustrates a logic flow diagram of a process for controlling athird modular device according to contextual information derived fromperioperative data received from a first modular device and a secondmodular device, in accordance with at least one aspect of the presentdisclosure;

FIG. 83A illustrates a diagram of a surgical hub communicably coupled toa particular set of modular devices and an Electronic Medical Record(EMR) database, in accordance with at least one aspect of the presentdisclosure;

FIG. 83B illustrates a diagram of a smoke evacuator including pressuresensors, in accordance with at least one aspect of the presentdisclosure;

FIG. 84A illustrates a logic flow diagram of a process for determining aprocedure type according to smoke evacuator perioperative data, inaccordance with at least one aspect of the present disclosure;

FIG. 84B illustrates a logic flow diagram of a process for determining aprocedure type according to smoke evacuator, insufflator, and medicalimaging device perioperative data, in accordance with at least oneaspect of the present disclosure;

FIG. 84C illustrates a logic flow diagram of a process for determining aprocedure type according to medical imaging device perioperative data,in accordance with at least one aspect of the present disclosure;

FIG. 84D illustrates a logic flow diagram of a process for determining aprocedural step according to insufflator perioperative data, inaccordance with at least one aspect of the present disclosure;

FIG. 84E illustrates a logic flow diagram of a process for determining aprocedural step according to energy generator perioperative data, inaccordance with at least one aspect of the present disclosure;

FIG. 84F illustrates a logic flow diagram of a process for determining aprocedural step according to energy generator perioperative data, inaccordance with at least one aspect of the present disclosure;

FIG. 84G illustrates a logic flow diagram of a process for determining aprocedural step according to stapler perioperative data, in accordancewith at least one aspect of the present disclosure;

FIG. 84H illustrates a logic flow diagram of a process for determining apatient status according to ventilator, pulse oximeter, blood pressuremonitor, and/or EKG monitor perioperative data, in accordance with atleast one aspect of the present disclosure;

FIG. 84I illustrates a logic flow diagram of a process for determining apatient status according to pulse oximeter, blood pressure monitor,and/or EKG monitor perioperative data, in accordance with at least oneaspect of the present disclosure;

FIG. 84J illustrates a logic flow diagram of a process for determining apatient status according to ventilator perioperative data, in accordancewith at least one aspect of the present disclosure;

FIG. 85A illustrates a scanner coupled to a surgical hub for scanning apatient wristband, in accordance with at least one aspect of the presentdisclosure;

FIG. 85B illustrates a scanner coupled to a surgical hub for scanning alist of surgical items, in accordance with at least one aspect of thepresent disclosure;

FIG. 86 illustrates a timeline of an illustrative surgical procedure andthe inferences that the surgical hub can make from the data detected ateach step in the surgical procedure, in accordance with at least oneaspect of the present disclosure;

FIG. 87A illustrates a flow diagram depicting the process of importingpatient data stored in an EMR database and deriving inferencestherefrom, in accordance with at least one aspect of the presentdisclosure;

FIG. 87B illustrates a flow diagram depicting the process of determiningcontrol adjustments corresponding to the derived inferences from FIG.87A, in accordance with at least one aspect of the present disclosure;

FIG. 88 illustrates a block diagram of a computer-implementedinteractive surgical system, in accordance with at least one aspect ofthe present disclosure;

FIG. 89 illustrates a logic flow diagram of tracking data associatedwith an operating theater event, in accordance with at least one aspectof the present disclosure;

FIG. 90 illustrates a diagram depicting how the data tracked by thesurgical hub can be parsed to provide increasingly detailed metrics, inaccordance with at least one aspect of the present disclosure;

FIG. 91 illustrates a bar graph depicting the number of patientsoperated on relative to the days of a week for different operatingrooms, in accordance with at least one aspect of the present disclosure;

FIG. 92 illustrates a bar graph depicting the total downtime betweenprocedures relative to the days of a week for a particular operatingroom, in accordance with at least one aspect of the present disclosure;

FIG. 93 illustrates a bar graph depicting the total downtime per day ofthe week depicted in FIG. 92 broken down according to each individualdowntime instance, in accordance with at least one aspect of the presentdisclosure;

FIG. 94 illustrates a bar graph depicting the average procedure lengthrelative to the days of a week for a particular operating room, inaccordance with at least one aspect of the present disclosure;

FIG. 95 illustrates a bar graph depicting procedure length relative toprocedure type, in accordance with at least one aspect of the presentdisclosure;

FIG. 96 illustrates a bar graph depicting the average completion timefor particular procedural steps for different types of thoracicprocedures, in accordance with at least one aspect of the presentdisclosure;

FIG. 97 illustrates a bar graph depicting procedure time relative toprocedure types, in accordance with at least one aspect of the presentdisclosure;

FIG. 98 illustrates a bar graph depicting operating room downtimerelative to the time of day, in accordance with at least one aspect ofthe present disclosure;

FIG. 99 illustrates a bar graph depicting operating room downtimerelative to the day of the week, in accordance with at least one aspectof the present disclosure;

FIG. 100 illustrates a pair of pie charts depicting the percentage oftime that the operating theater is utilized, in accordance with at leastone aspect of the present disclosure;

FIG. 101 illustrates a bar graph depicting consumed and unused surgicalitems relative to procedure type, in accordance with at least one aspectof the present disclosure;

FIG. 102 illustrates a logic flow diagram of a process for storing datafrom the modular devices and patient information database forcomparison, in accordance with at least one aspect of the presentdisclosure;

FIG. 103 illustrates a diagram of a distributed computing system, inaccordance with at least one aspect of the present disclosure;

FIG. 104 illustrates a logic flow diagram of a process for shiftingdistributed computing resources, in accordance with at least one aspectof the present disclosure;

FIG. 105 illustrates a diagram of an imaging system and a surgicalinstrument bearing a calibration scale, in accordance with at least oneaspect of the present disclosure;

FIG. 106 illustrates a diagram of a surgical instrument centered on alinear staple transection line using the benefit of centering tools andtechniques described in connection with FIGS. 107-119 , in accordancewith at least one aspect of the present disclosure;

FIGS. 107-109 illustrate a process of aligning an anvil trocar of acircular stapler to a staple overlap portion of a linear staple linecreated by a double-stapling technique, in accordance with at least oneaspect of the present disclosure, where:

FIG. 107 illustrates an anvil trocar of a circular stapler that is notaligned with a staple overlap portion of a linear staple line created bya double-stapling technique;

FIG. 108 illustrates an anvil trocar of a circular stapler that isaligned with the center of the staple overlap portion of the linearstaple line created by a double-stapling technique; and

FIG. 109 illustrates a centering tool displayed on a surgical hubdisplay showing a staple overlap portion of a linear staple line createdby a double-stapling technique to be cut out by a circular stapler,where the anvil trocar is not aligned with the staple overlap portion ofthe double staple line as shown in FIG. 107 ;

FIGS. 110 and 111 illustrate a before image and an after image of acentering tool, in accordance with at least one aspect of the presentdisclosure, where:

FIG. 110 illustrates an image of a projected cut path of an anvil trocarand circular knife before alignment with the target alignment ringcircumscribing the image of the linear staple line over the image of thestaple overlap portion presented on a surgical hub display; and

FIG. 111 illustrates an image of a projected cut path of an anvil trocarand circular knife after alignment with the target alignment ringcircumscribing the image of the linear staple line over the image of thestaple overlap portion presented on a surgical hub display;

FIGS. 112-114 illustrate a process of aligning an anvil trocar of acircular stapler to a center of a linear staple line, in accordance withat least one aspect of the present disclosure, where:

FIG. 112 illustrates the anvil trocar out of alignment with the centerof the linear staple line;

FIG. 113 illustrates the anvil trocar in alignment with the center ofthe linear staple line; and

FIG. 114 illustrates a centering tool displayed on a surgical hubdisplay of a linear staple line, where the anvil trocar is not alignedwith the staple overlap portion of the double staple line as shown inFIG. 112 ;

FIG. 115 is an image of a standard reticle field view of a linear stapleline transection of a surgical as viewed through a laparoscope displayedon the surgical hub display, in accordance with at least one aspect ofthe present disclosure;

FIG. 116 is an image of a laser-assisted reticle field of view of thesurgical site shown in FIG. 115 before the anvil trocar and circularknife of the circular stapler are aligned to the center of the linearstaple line, in accordance with at least one aspect of the presentdisclosure;

FIG. 117 is an image of a laser-assisted reticle field of view of thesurgical site shown in FIG. 116 after the anvil trocar and circularknife of the circular stapler are aligned to the center of the linearstaple line, in accordance with at least one aspect of the presentdisclosure;

FIG. 118 illustrates a non-contact inductive sensor implementation of anon-contact sensor to determine an anvil trocar location relative to thecenter of a staple line transection, in accordance with at least oneaspect of the present disclosure;

FIGS. 119A and 119B illustrate one aspect of a non-contact capacitivesensor implementation of the non-contact sensor to determine an anviltrocar location relative to the center of a staple line transection, inaccordance with at least one aspect of the present disclosure, where:

FIG. 119A shows the non-contact capacitive sensor without a nearby metaltarget; and

FIG. 119B shows the non-contact capacitive sensor near a metal target;

FIG. 120 is a logic flow diagram of a process depicting a controlprogram or a logic configuration for aligning a surgical instrument, inaccordance with at least one aspect of the present disclosure;

FIG. 121 illustrates a primary display of the surgical hub comprising aglobal and local display, in accordance with at least one aspect of thepresent disclosure;

FIG. 122 illustrates a primary display of the surgical hub, inaccordance with at least one aspect of the present disclosure;

FIG. 123 illustrates a clamp stabilization sequence over a five secondperiod, in accordance with at least one aspect of the presentdisclosure;

FIG. 124 illustrates a diagram of four separate wide angle view imagesof a surgical site at four separate times during the procedure, inaccordance with at least one aspect of the present disclosure;

FIG. 125 is a graph of tissue creep clamp stabilization curves for twotissue types, in accordance with at least one aspect of the presentdisclosure;

FIG. 126 is a graph of time dependent proportionate fill of a clampforce stabilization curve, in accordance with at least one aspect of thepresent disclosure;

FIG. 127 is a graph of the role of tissue creep in the clamp forcestabilization curve, in accordance with at least one aspect of thepresent disclosure;

FIGS. 128A and 128B illustrate two graphs for determining when theclamped tissue has reached creep stability, in accordance with at leastone aspect of the present disclosure, where:

FIG. 128A illustrates a curve that represents a vector tangent angle dθas a function of time; and

FIG. 128B illustrates a curve that represents change in force-to-close(ΔFTC) as a function of time;

FIG. 129 illustrates an example of an augmented video image of apre-operative video image augmented with data identifying displayedelements, in accordance with at least one aspect of the presentdisclosure;

FIG. 130 is a logic flow diagram of a process depicting a controlprogram or a logic configuration to display images, in accordance withat least one aspect of the present disclosure;

FIG. 131 illustrates a communication system comprising an intermediatesignal combiner positioned in the communication path between an imagingmodule and a surgical hub display, in accordance with at least oneaspect of the present disclosure;

FIG. 132 illustrates an independent interactive headset worn by asurgeon to communicate data to the surgical hub, according to one aspectof the present disclosure;

FIG. 133 illustrates a method for controlling the usage of a device, inaccordance with at least one aspect of the present disclosure, inaccordance with at least one aspect of the present disclosure;

FIG. 134 illustrates a surgical system that includes a handle having acontroller and a motor, an adapter releasably coupled to the handle, anda loading unit releasably coupled to the adapter, in accordance with atleast one aspect of the present disclosure;

FIG. 135 illustrates a verbal Automated Endoscopic System for OptimalPositioning (AESOP) camera positioning system, in accordance with atleast one aspect of the present disclosure;

FIG. 136 illustrates a multi-functional surgical control system andswitching interface for virtual operating room integration, inaccordance with at least one aspect of the present disclosure;

FIG. 137 illustrates a diagram of a beam source and combined beamdetector system utilized as a device control mechanism in an operatingtheater, in accordance with at least one aspect of the presentdisclosure;

FIGS. 138A-E illustrate various types of sterile field control and datainput consoles, in accordance with at least one aspect of the presentdisclosure, where:

FIG. 138A illustrates a single zone sterile field control and data inputconsole;

FIG. 138B illustrates a multi zone sterile field control and data inputconsole;

FIG. 138C illustrates a tethered sterile field control and data inputconsole;

FIG. 138D illustrates a battery operated sterile field control and datainput console; and

FIG. 138E illustrates a battery operated sterile field control and datainput console;

FIGS. 139A-139B illustrate a sterile field console in use in a sterilefield during a surgical procedure, in accordance with at least oneaspect of the present disclosure, where:

FIG. 139A shows the sterile field console positioned in the sterilefield near two surgeons engaged in an operation; and

FIG. 139B shows one of the surgeons tapping the touchscreen of thesterile field console;

FIG. 140 illustrates a process for accepting consult feeds from anotheroperating room, in accordance with at least one aspect of the presentdisclosure;

FIG. 141 illustrates a standard technique for estimating vessel path anddepth and device trajectory, in accordance with at least one aspect ofthe present disclosure;

FIGS. 142A-142D illustrate multiple real time views of images of avirtual anatomical detail for dissection, in accordance with at leastone aspect of the present disclosure, where:

FIG. 142A is a perspective view of the virtual anatomical detail;

FIG. 142B is a side view of the virtual anatomical detail;

FIG. 142C is a perspective view of the virtual anatomical detail; and

FIG. 142D is a side view of the virtual anatomical detail;

FIGS. 143A-143B illustrate a touchscreen display that may be used withinthe sterile field, in accordance with at least one aspect of the presentdisclosure, where:

FIG. 143A illustrates an image of a surgical site displayed on atouchscreen display in portrait mode;

FIG. 143B shows the touchscreen display rotated in landscape mode andthe surgeon uses his index finger to scroll the image in the directionof the arrows;

FIG. 143C shows the surgeon using his index finger and thumb to pinchopen the image in the direction of the arrows to zoom in;

FIG. 143D shows the surgeon using his index finger and thumb to pinchclose the image in the direction of the arrows to zoom out; and

FIG. 143E shows the touchscreen display rotated in two directionsindicated by arrows to enable the surgeon to view the image in differentorientations;

FIG. 144 illustrates a surgical site employing a smart retractorcomprising a direct interface control to a surgical hub, in accordancewith at least one aspect of the present disclosure;

FIG. 145 illustrates a surgical site with a smart flexible stickerdisplay attached to the body of a patient, in accordance with at leastone aspect of the present disclosure;

FIG. 146 is a logic flow diagram of a process depicting a controlprogram or a logic configuration to communicate from inside a sterilefield to a device located outside the sterile field, in accordance withat least one aspect of the present disclosure;

FIG. 147 illustrates a system for performing surgery, in accordance withat least one aspect of the present disclosure;

FIG. 148 illustrates a second layer of information overlaying a firstlayer of information, in accordance with at least one aspect of thepresent disclosure;

FIG. 149 depicts a perspective view of a surgeon using a surgicalinstrument that includes a handle assembly housing and a wirelesscircuit board during a surgical procedure, with the surgeon wearing aset of safety glasses, in accordance with at least one aspect of thepresent disclosure;

FIG. 150 is a schematic diagram of a feedback control system forcontrolling a surgical instrument, in accordance with at least oneaspect of the present disclosure;

FIG. 151 illustrates a feedback controller that includes an on-screendisplay module and a heads up display (HUD) module, in accordance withat least one aspect of the present disclosure;

FIG. 152A illustrates a visualization system that may be incorporatedinto a surgical system, in accordance with at least one aspect of thepresent disclosure;

FIG. 152B illustrates a top plan view of a hand unit of thevisualization system of FIG. 152A, in accordance with at least oneaspect of the present disclosure;

FIG. 152C illustrates a side plan view of the hand unit depicted in FIG.152A along with an imaging sensor disposed therein, in accordance withat least one aspect of the present disclosure;

FIG. 152D illustrates a plurality of an imaging sensors a depicted inFIG. 152C, in accordance with at least one aspect of the presentdisclosure;

FIG. 153A illustrates a plurality of laser emitters that may beincorporated in the visualization system of FIG. 152A, in accordancewith at least one aspect of the present disclosure;

FIG. 153B illustrates illumination of an image sensor having a Bayerpattern of color filters, in accordance with at least one aspect of thepresent disclosure;

FIG. 153C illustrates a graphical representation of the operation of apixel array for a plurality of frames, in accordance with at least oneaspect of the present disclosure;

FIG. 153D illustrates a schematic of an example of an operation sequenceof chrominance and luminance frames, in accordance with at least oneaspect of the present disclosure;

FIG. 153E illustrates an example of sensor and emitter patterns, inaccordance with at least one aspect of the present disclosure;

FIG. 153F illustrates a graphical representation of the operation of apixel array, in accordance with at least one aspect of the presentdisclosure;

FIG. 154 illustrates a schematic of one example of instrumentation forNIR spectroscopy, according to one aspect of the present disclosure;

FIG. 155 illustrates schematically one example of instrumentation fordetermining NIRS based on Fourier transform infrared imaging, inaccordance with at least one aspect of the present disclosure;

FIGS. 156A-C illustrate a change in wavelength of light scattered frommoving blood cells, in accordance with at least one aspect of thepresent disclosure;

FIG. 157 illustrates an aspect of instrumentation that may be used todetect a Doppler shift in laser light scattered from portions of atissue, in accordance with at least one aspect of the presentdisclosure;

FIG. 158 illustrates schematically some optical effects on lightimpinging on a tissue having subsurface structures, in accordance withat least one aspect of the present disclosure;

FIG. 159 illustrates an example of the effects on a Doppler analysis oflight impinging on a tissue sample having subsurface structures, inaccordance with at least one aspect of the present disclosure;

FIGS. 160A-C illustrate schematically the detection of moving bloodcells at a tissue depth based on a laser Doppler analysis at a varietyof laser wavelengths, in accordance with at least one aspect of thepresent disclosure;

FIG. 160D illustrates the effect of illuminating a CMOS imaging sensorwith a plurality of light wavelengths over time, in accordance with atleast one aspect of the present disclosure;

FIG. 161 illustrates an example of a use of Doppler imaging to detectthe present of subsurface blood vessels, in accordance with at least oneaspect of the present disclosure;

FIG. 162 illustrates a method to identify a subsurface blood vesselbased on a Doppler shift of blue light due to blood cells flowingtherethrough, in accordance with at least one aspect of the presentdisclosure;

FIG. 163 illustrates schematically localization of a deep subsurfaceblood vessel, in accordance with at least one aspect of the presentdisclosure;

FIG. 164 illustrates schematically localization of a shallow subsurfaceblood vessel, in accordance with at least one aspect of the presentdisclosure;

FIG. 165 illustrates a composite image comprising a surface image and animage of a subsurface blood vessel, in accordance with at least oneaspect of the present disclosure;

FIG. 166 is a flow chart of a method for determining a depth of asurface feature in a piece of tissue, in accordance with at least oneaspect of the present disclosure;

FIG. 167 illustrates the effect of the location and characteristics ofnon-vascular structures on light impinging on a tissue sample, inaccordance with at least one aspect of the present disclosure;

FIG. 168 schematically depicts one example of components used in a fullfield OCT device, in accordance with at least one aspect of the presentdisclosure;

FIG. 169 illustrates schematically the effect of tissue anomalies onlight reflected from a tissue sample, in accordance with at least oneaspect of the present disclosure;

FIG. 170 illustrates an image display derived from a combination oftissue visualization modalities, in accordance with at least one aspectof the present disclosure;

FIGS. 171A-C illustrate several aspects of displays that may be providedto a surgeon for a visual identification of a combination of surface andsub-surface structures of a tissue in a surgical site, in accordancewith at least one aspect of the present disclosure;

FIG. 172 is a flow chart of a method for providing information relatedto a characteristic of a tissue to a smart surgical instrument, inaccordance with at least one aspect of the present disclosure;

FIGS. 173A and 173B illustrate a multi-pixel light sensor receiving bylight reflected by a tissue illuminated by sequential exposure to red,green, blue, and infrared light, and red, green, blue, and ultravioletlaser light sources, respectively, in accordance with at least oneaspect of the present disclosure;

FIGS. 174A and 174B illustrate the distal end of an elongated cameraprobe having a single light sensor and two light sensors, respectively,in accordance with at least one aspect of the present disclosure;

FIG. 174C illustrates a perspective view of an example of a monolithicsensor having a plurality of pixel arrays, in accordance with at leastone aspect of the present disclosure;

FIG. 175 illustrates one example of a pair of fields of view availableto two image sensors of an elongated camera probe, in accordance with atleast one aspect of the present disclosure;

FIGS. 176A-D illustrate additional examples of a pair of fields of viewavailable to two image sensors of an elongated camera probe, inaccordance with at least one aspect of the present disclosure;

FIGS. 177A-C illustrate an example of the use of an imaging systemincorporating the features disclosed in FIG. 176D, in accordance with atleast one aspect of the present disclosure;

FIGS. 178A and 178B depict another example of the use of a dual imagingsystem, in accordance with at least one aspect of the presentdisclosure;

FIGS. 179A-C illustrate examples of a sequence of surgical steps whichmay benefit from the use of multi-image analysis at the surgical site,in accordance with at least one aspect of the present disclosure;

FIG. 180 is a block diagram of the computer-implemented interactivesurgical system, in accordance with at least one aspect of the presentdisclosure;

FIG. 181 is a block diagram which illustrates the functionalarchitecture of the computer-implemented interactive surgical system, inaccordance with at least one aspect of the present disclosure;

FIG. 182 is an example illustration of a tabulation of various resourcescorrelated to particular types of surgical categories, in accordancewith at least one aspect of the present disclosure;

FIG. 183 provides an example illustration of how data is analyzed by thecloud system to provide a comparison between multiple facilities tocompare use of resources, in accordance with at least one aspect of thepresent disclosure;

FIG. 184 illustrates one example of how the cloud system may determineefficacy trends from an aggregated set of data across whole regions, inaccordance with at least one aspect of the present disclosure;

FIG. 185 provides an example illustration of some types of analysis thecloud system may be configured to perform to provide the predictingmodeling, in accordance with at least one aspect of the presentdisclosure;

FIG. 186 provides a graphical illustration of a type of example analysisthe cloud system may perform to provide these recommendations, inaccordance with at least one aspect of the present disclosure;

FIG. 187 provides an illustration of how the cloud system may conductanalysis to identify a statistical correlation to a local issue that istied to how a device is used in the localized setting, in accordancewith at least one aspect of the present disclosure;

FIG. 188 provides a graphical illustration of an example of how somedevices may satisfy an equivalent use compared to an intended device,and that the cloud system may determine such equivalent use, inaccordance with at least one aspect of the present disclosure;

FIG. 189 provides various examples of how some data may be used asvariables in deciding how a post-operative decision tree may branch out,in accordance with at least one aspect of the present disclosure;

FIG. 190 illustrates a block diagram of a computer-implementedinteractive surgical system that is configured to adaptively generatecontrol program updates for modular devices, in accordance with at leastone aspect of the present disclosure;

FIG. 191 illustrates a logic flow diagram of a process for updating thecontrol program of a modular device, in accordance with at least oneaspect of the present disclosure;

FIG. 192 illustrates a diagram of an illustrative analytics systemupdating a surgical instrument control program, in accordance with atleast one aspect of the present disclosure;

FIG. 193 illustrates a diagram of an analytics system pushing an updateto a modular device through a surgical hub, in accordance with at leastone aspect of the present disclosure;

FIG. 194 illustrates a diagram of a computer-implemented interactivesurgical system that is configured to adaptively generate controlprogram updates for surgical hubs, in accordance with at least oneaspect of the present disclosure;

FIG. 195 illustrates a logic flow diagram of a process for updating thecontrol program of a surgical hub, in accordance with at least oneaspect of the present disclosure;

FIG. 196 illustrates a logic flow diagram of a process for updating thedata analysis algorithm of a control program of a surgical hub, inaccordance with at least one aspect of the present disclosure;

FIG. 197 provides an illustration of example functionality by a cloudmedical analytics system for providing improved security andauthentication to multiple medical facilities that are interconnected,in accordance with at least one aspect of the present disclosure;

FIG. 198 is a flow diagram of the computer-implemented interactivesurgical system programmed to use screening criteria to determinecritical data and to push requests to a surgical hub to obtainadditional data, in accordance with at least one aspect of the presentdisclosure;

FIG. 199 is a flow diagram of an aspect of responding to critical databy the computer-implemented interactive surgical system, in accordancewith at least one aspect of the present disclosure;

FIG. 200 is a flow diagram of an aspect of data sorting andprioritization by the computer-implemented interactive surgical system,in accordance with at least one aspect of the present disclosure;

FIG. 201 illustrates an example system for implementing automatedinventory control, in accordance with at least one aspect of the presentdisclosure;

FIG. 202 illustrates one example of an institution's cloud interfacethrough which a proposed surgical procedure may be entered, inaccordance with at least one aspect of the present disclosure;

FIG. 203 illustrates one example of an institution's cloud interfacethrough which a cloud-based system provides knowledge regarding theavailability and/or usability of inventory items associated with anentered surgical procedure based on system-defined constraints, inaccordance with at least one aspect of the present disclosure;

FIG. 204 illustrates a surgical tool including modular componentswherein the status of each modular component is evaluated based onsystem-defined constraints, in accordance with at least one aspect ofthe present disclosure;

FIG. 205 is a schematic of a robotic surgical system, in accordance withone aspect of the present disclosure;

FIG. 206 is a plan view of a minimally invasivetelesurgically-controlled robotic surgical system being used to performa surgery, in accordance with one aspect of the present disclosure;

FIG. 207 is a perspective view of a surgeon's control console of thesurgical system of FIG. 206 , in accordance with one aspect of thepresent disclosure;

FIG. 208 is a perspective view of an electronics cart of the surgicalsystem of FIG. 206 , in accordance with one aspect of the presentdisclosure;

FIG. 209 is a diagram of a telesurgically-controlled surgical system, inaccordance with one aspect of the present disclosure;

FIG. 210 is a partial view of a patient side cart of the surgical systemof FIG. 206 , in accordance with one aspect of the present disclosure;

FIG. 211 is a front view of a telesurgically-operated surgery tool forthe surgical system of FIG. 206 , in accordance with one aspect of thepresent disclosure;

FIG. 212 is a control schematic diagram of a telesurgically-controlledsurgical system, in accordance with one aspect of the presentdisclosure;

FIG. 213 is an elevation view of a robotic surgical system and variouscommunication paths thereof, in accordance with one aspect of thepresent disclosure;

FIG. 214 is a perspective, exploded view of an interface between arobotic tool and a tool mounting portion of the robotic surgical systemof FIG. 213 ;

FIG. 215 is a detail view of the interface of FIG. 214 , in accordancewith one aspect of the present disclosure;

FIG. 216 is a perspective view of a bipolar radio frequency (RF) robotictool having a smoke evacuation pump for use with a robotic surgicalsystem, in accordance with one aspect of the present disclosure;

FIG. 217 is a perspective view of the end effector of the bipolar radiofrequency robotic tool of FIG. 216 depicting the end effector clampingand treating tissue, in accordance with one aspect of the presentdisclosure;

FIG. 218 is a plan view of the tool drive interface of the bipolar radiofrequency robotic tool of FIG. 216 with components removed for clarity,in accordance with one aspect of the present disclosure;

FIG. 219 is a plan view of an ultrasonic robotic tool having cooling andinsufflation features for use with a robotic surgical system, inaccordance with one aspect of the present disclosure;

FIG. 220 is a flow chart of a control algorithm for a robotic tool foruse with a robotic surgical system, in accordance with one aspect of thepresent disclosure;

FIG. 221 is a perspective view of a drive system for a robotic surgicaltool, in accordance with one aspect of the present disclosure;

FIG. 222 is an exploded perspective view of the drive system of FIG. 221, in accordance with at least one aspect of the present disclosure;

FIG. 223 is a perspective, partial cross-section view of a proximalhousing of the robotic surgical tool of FIG. 221 , depicting atransmission arrangement within the proximal housing, in accordance withat least one aspect of the present disclosure;

FIG. 224 is an exploded perspective view of the transmission arrangementof FIG. 223 , in accordance with one aspect of the present disclosure;

FIG. 225 is an exploded perspective view of the transmission arrangementof FIG. 223 with various parts removed for clarity, depicting thetransmission arrangement in a first configuration in which a firstcooperative drive is drivingly coupled to a first output shaft and asecond cooperative drive is drivingly coupled to a second output shaft,in accordance with one aspect of the present disclosure;

FIG. 226 is an exploded perspective view of the transmission arrangementof FIG. 223 with various parts removed for clarity, depicting thetransmission arrangement in a second configuration in which the firstcooperative drive and the second cooperative drive are drivingly coupledto a third output shaft, in accordance with one aspect of the presentdisclosure;

FIG. 227 is an exploded perspective view of the transmission arrangementof FIG. 223 with various parts removed for clarity, depicting thetransmission arrangement in a third configuration in which the firstcooperative drive and the second cooperative drive are drivingly coupledto a fourth output shaft, in accordance with one aspect of the presentdisclosure;

FIG. 228 is an exploded, cross-section elevation view of thetransmission arrangement of FIG. 223 , in accordance with at least oneaspect of the present disclosure;

FIG. 229 is a graphical display of output torque for different surgicalfunctions of the robotic surgical tool of FIG. 221 , in accordance withat least one aspect of the present disclosure;

FIG. 230 is a perspective view of the robotic surgical tool of FIG. 221in an unactuated configuration, in accordance with one aspect of thepresent disclosure;

FIG. 231 is a perspective view of the robotic surgical tool of FIG. 221in an articulated configuration, in accordance with one aspect of thepresent disclosure;

FIG. 232 is a perspective view of the robotic surgical tool of FIG. 221in a rotated configuration, in accordance with one aspect of the presentdisclosure;

FIG. 233 is a perspective view of the robotic surgical tool of FIG. 221in a clamped and fired configuration, in accordance with one aspect ofthe present disclosure;

FIG. 234 is a view of robotically-controlled end effectors at a surgicalsite, in accordance with one aspect of the present disclosure;

FIG. 235 is a view of the robotically-controlled end effectors of FIG.234 , in accordance with one aspect of the present disclosure;

FIG. 236 is a graphical display of force and displacement over time forone of the robotically-controlled end effectors of FIG. 234 , inaccordance with one aspect of the present disclosure;

FIG. 237 is a flow chart of a control algorithm for one a surgical toolfor use with a robotic surgical system, in accordance with one aspect ofthe present disclosure;

FIG. 238 is an elevation view of a surgical procedure involving arobotic surgical system and a handheld surgical instrument and depictingmultiple displays in the surgical theater, in accordance with one aspectof the present disclosure;

FIG. 239 is a schematic of a robotic surgical system, in accordance withat least one aspect of the present disclosure;

FIG. 240 is a block diagram of control components for the roboticsurgical system of FIG. 239 , in accordance with at least one aspect ofthe present disclosure;

FIG. 241A is an elevation view of an ultrasonic surgical tool positionedout of contact with tissue, in accordance with at least one aspect ofthe present disclosure;

FIG. 241B is an elevation view of the ultrasonic surgical tool of FIG.241A positioned in abutting contact with tissue, in accordance with atleast one aspect of the present disclosure;

FIG. 242A is an elevation view of a monopolar cautery pencil positionedout of contact with tissue, in accordance with at least one aspect ofthe present disclosure;

FIG. 242B is an elevation view of the monopolar cautery pencil of FIG.242A positioned in abutting contact with tissue, in accordance with atleast one aspect of the present disclosure;

FIG. 243 is a graphical display of continuity and current over time forthe ultrasonic surgical tool of FIGS. 241A and 241B, in accordance withat least one aspect of the present disclosure;

FIG. 244 illustrates an end effector comprising radio frequency (RF)data sensors located on a jaw member, in accordance with at least oneaspect of the present disclosure;

FIG. 245 illustrates the sensors shown in FIG. 244 mounted to or formedintegrally with a flexible circuit, in accordance with at least oneaspect of the present disclosure;

FIG. 246 is a flow chart depicting an automatic activation mode of asurgical instrument, in accordance with at least one aspect of thepresent disclosure;

FIG. 247 is a perspective view of an end effector of a bipolar radiofrequency (RF) surgical tool having a smoke evacuation pump for use witha robotic surgical system, depicting the surgical tool clamping andtreating tissue, in accordance with at least one aspect of the presentdisclosure;

FIG. 248 is a block diagram of a surgical system comprising a roboticsurgical system, a handheld surgical instrument, and a surgical hub, inaccordance with at least one aspect of the present disclosure;

FIG. 249 is a perspective view of a handle portion of a handheldsurgical instrument including a display and further depicting a detailview of the display depicting information from the instrument itself, inaccordance with at least one aspect of the present disclosure;

FIG. 250 is a perspective view of the handle portion of the handheldsurgical instrument of FIG. 249 depicting the instrument paired with asurgical hub and further including a detail view of the displaydepicting information from the surgical hub, in accordance with at leastone aspect of the present disclosure;

FIG. 251 is a schematic of a colon resection procedure, in accordancewith at least one aspect of the present disclosure;

FIG. 252 is a graphical display of force over time for the colonresection procedure displayed on the instrument display in FIG. 251 , inaccordance with at least one aspect of the present disclosure;

FIG. 253 is a schematic of a robotic surgical system during a surgicalprocedure including a plurality of hubs and interactive secondarydisplays, in accordance with at least one aspect of the presentdisclosure;

FIG. 254 is a detail view of the interactive secondary displays of FIG.253 , in accordance with at least one aspect of the present disclosure;

FIG. 255 is a block diagram of a robotic surgical system comprising morethan one robotic arm, in accordance with at least one aspect of thepresent disclosure;

FIG. 256 is a schematic of a surgical procedure utilizing the roboticsurgical system of FIG. 255 , in accordance with at least one aspect ofthe present disclosure;

FIG. 257 shows graphical representations of forces and positionaldisplacements experienced by the robotic arms of FIG. 255 , inaccordance with at least one aspect of the present disclosure;

FIG. 258 is a flow chart depicting an algorithm for controlling theposition of the robotic arms of a robotic surgical system, in accordancewith at least one aspect of the present disclosure;

FIG. 259 is a flow chart depicting an algorithm for controlling theforces exerted by robotic arms of a robotic surgical system, inaccordance with at least one aspect of the present disclosure;

FIG. 260 is a flow chart depicting an algorithm for monitoring theposition and forces exerted by robotic arms of a robotic surgicalsystem, in accordance with at least one aspect of the presentdisclosure;

FIG. 261 is a block diagram of a surgical system comprising a roboticsurgical system, a powered handheld surgical instrument, and a surgicalhub, in accordance with at least one aspect of the present disclosure;

FIG. 262 is a perspective view of a robotic tool and a handheld surgicalinstrument during a surgical procedure, in accordance with at least oneaspect of the present disclosure;

FIG. 263 is a schematic depicting communication links between surgicalhubs and a primary server, in accordance with at least one aspect of thepresent disclosure;

FIG. 264 is a flow chart depicting a queue for external output of datareceived from the various surgical hubs of FIG. 263 , in accordance withat least one aspect of the present disclosure;

FIG. 265 is a perspective view of a robot arm of a robotic surgicalsystem and schematically depicts additional components of the roboticsurgical system, in accordance with one aspect of the presentdisclosure;

FIG. 266 is a perspective view of a robotic arm of a robotic surgicalsystem, and further depicts an operator manually adjusting the positionof the robotic arm, in accordance with one aspect of the presentdisclosure;

FIG. 267 is a graphical display of force over time of the robotic arm ofFIG. 266 in a passive power assist mode, in accordance with one aspectof the present disclosure;

FIG. 268 is a perspective view of a robotic arm and a secondaryinteractive display within a sterile field, in accordance with at leastone aspect of the present disclosure.

FIG. 269 is a graphical display of force over time of the robotic arm ofFIG. 268 , in accordance with one aspect of the present disclosure;

FIG. 270 is a perspective view of a robotic arm and a robotic hub of arobotic surgical system, in accordance with at least one aspect of thepresent disclosure;

FIG. 271 is a detail view of an end effector of a linear staplerattached to the robotic arm of FIG. 270 , depicting the end effectorpositioned relative to a targeted tissue region during a surgicalprocedure, in accordance with at least one aspect of the presentdisclosure;

FIG. 272 is a graphical display of distance and force-to-close over timefor the linear stapler of FIG. 271 , in accordance with one aspect ofthe present disclosure;

FIG. 273 is a schematic depicting a robotic surgical system having aplurality of sensing systems, in accordance with one aspect of thepresent disclosure;

FIG. 273A is a detail view of a trocar of FIG. 273 , in accordance withat least one aspect of the present disclosure;

FIG. 274 is a flowchart depicting a robotic surgical system utilizing aplurality of independent sensing systems, in accordance with one aspectof the present disclosure;

FIG. 275 is a partial perspective view of a clip applier;

FIG. 276 is a cross-sectional view of an end effector of the clipapplier of FIG. 275 comprising a removable clip cartridge, areciprocating firing drive for sequentially advancing the clips, areceiver for receiving the clips, and a crimping drive for deforming theclips;

FIG. 277 is a partial cross-sectional view of the clip applier of FIG.275 in an open configuration;

FIG. 278 is a partial cross-sectional view of the clip applier of FIG.275 in a closed configuration;

FIG. 279 is a cross-sectional view of the end effector of FIG. 276 in anunfired condition;

FIG. 280 is a cross-sectional view of the end effector of FIG. 276illustrating the firing drive in a partially fired condition in which afiring member of the firing drive has advanced a clip into the receiver;

FIG. 281 is a cross-sectional view of the end effector of FIG. 276illustrating the firing drive coming into engagement with the crimpingdrive;

FIG. 282 is a cross-sectional view of the end effector of FIG. 276illustrating the crimping drive in an at least partially firedcondition;

FIG. 283 is a cross-sectional view of the end effector of FIG. 276illustrating the firing drive becoming disengaged from the firingmember;

FIG. 284 is a cross-sectional view of the end effector of FIG. 276illustrating the crimping drive in its fully fired condition;

FIG. 285 is a cross-sectional view of the firing drive of the endeffector of FIG. 276 in a partially retracted position in which thefiring drive is being re-engaged with the firing member;

FIG. 286 is a cross-sectional view of the firing drive of the endeffector of FIG. 276 being disengaged from the crimping drive;

FIG. 287 is a perspective view of a clip illustrated in FIGS. 276-286 ;

FIG. 288 is a front view of a cartridge illustrated in FIGS. 275-286comprising a plurality of clips with portions of the cartridge removedto illustrate the clips stored in the cartridge;

FIG. 289 is a side view of the cartridge of FIG. 288 illustrated withportions removed to illustrate the clips stored in the cartridge;

FIG. 290 is a cross-sectional plan view of the cartridge of FIG. 288taken along line 290-290 in FIG. 289 ;

FIG. 291 is a side view of an alternative cartridge usable in connectionwith the clip applier of FIGS. 275-286 or any other suitable clipapplier, wherein the cartridge is illustrated with portions removed toillustrate a biasing member and a pusher plate positioned intermediatethe biasing member and the clips contained therein;

FIG. 292 is a side view of a cartridge in accordance with at least onealternative embodiment illustrated with portions removed to illustrate abiasing member and a lockout plate positioned intermediate the biasingmember and the clips contained therein;

FIG. 293 is a cross-sectional plan view of the cartridge of FIG. 292taken along line 293-293 in FIG. 292 ;

FIG. 294 is a side view of a further alternative cartridge usable inconnection with the clip applier of FIGS. 275-286 or any other suitableclip applier, wherein the cartridge can comprise a housing illustratedwith portions removed to illustrate a lockout plate comprising guideswhich are configured to co-operate with guides defined in the cartridgehousing;

FIG. 295 is a cross-sectional plan view of the cartridge of FIG. 294taken along line 295-295 in FIG. 294 ;

FIG. 296 is an elevational view of a firing drive comprising a rotaryinput, a rotary output, a firing nut engaged with the rotary output, anda transmission in a firing configuration in accordance with at least oneembodiment;

FIG. 297 is a perspective view of the firing drive of FIG. 296illustrating the firing nut in an unfired position;

FIG. 298 is a perspective view of the firing drive of FIG. 296illustrating the firing nut advanced along the rotary output and a camextending from the firing nut;

FIG. 299 is a perspective view of the firing drive of FIG. 296illustrating the cam of the firing nut engaged with the transmission ofthe firing drive and the transmission in a reverse configuration;

FIG. 300 is a perspective view of the firing drive of FIG. 296illustrating firing nut in a retracted position and a second camextending from the firing nut engaged with the transmission to shift thetransmission from its reverse configuration to its firing configuration;

FIG. 301 is a perspective view of a robotic surgical instrument systemoperably supporting a plurality of surgical tools usable with the clipapplier of FIGS. 276-286 or any other suitable clip applier;

FIG. 302 is a perspective view of a surgical tool including an actuatormodule, a shaft extending from the actuator module, and a replaceableend effector;

FIG. 303 is a perspective view of a handle actuator usable with the clipapplier of FIGS. 276-286 or any other suitable clip applier;

FIG. 304 is a cross-sectional view of the articulation joint illustratedin FIG. 276 ;

FIG. 305 is a rear perspective view of an alternative actuator modulethat may be used in place of the actuator module of FIG. 302 with atleast a portion of its housing removed;

FIG. 306 is an exploded view of a portion of the actuator module of FIG.305 ;

FIG. 307 is a partial sectional view of the actuator module of FIG. 305;

FIG. 308 is a cross-sectional view of an articulation actuator of theactuator module of FIG. 305 ;

FIG. 309 is a partial cross-sectional view of an end effector of a clipapplier in a closed configuration;

FIG. 310 is a partial cross-sectional view of the end effector of FIG.309 in an open configuration;

FIG. 311 is a cross-sectional view of the end effector of FIG. 309 in anopen configuration;

FIG. 312 is a partial cross-sectional view of the end effector of FIG.309 illustrating the position of a stored clip when a crimping drive ofthe end effector is in a fully fired position;

FIG. 313 is a partial cross-sectional view of the end effector of FIG.309 illustrating the position of the stored clip when the crimping driveis in a home position;

FIG. 314 is a partial cross-sectional view of the end effector of FIG.309 illustrating the position of the stored clip when the crimping driveis in a fully retracted position;

FIG. 315 is a partial cross-sectional view of a clip applier comprisinga clip cartridge containing clips having a first size;

FIG. 316 is a partial cross-sectional view of the clip applier of FIG.315 comprising a different clip cartridge containing clips having asecond size;

FIG. 317 is a partial cross-sectional view of a multi-level clip stackarrangement;

FIG. 318 is a perspective view of a clip applier comprising anattachment mechanism;

FIG. 319 is a cross-sectional view of the clip applier of FIG. 319 ;

FIG. 320 is a perspective view of a clip applier comprising a clipmagazine;

FIG. 321 is a perspective view of clips for use with the clip applier ofFIG. 320 ;

FIG. 322 is a perspective view of a clip reloader for use with a clipapplier comprising a clip magazine;

FIG. 323 is a perspective view of a clip reloader;

FIG. 324 is a cross-sectional view of the clip reloader of FIG. 323 ;

FIG. 325 is a cross-sectional view of the clip reloader of FIG. 323 andan end effector of a clip applier;

FIG. 326 is a partial cross-sectional plan view of a clip applier;

FIG. 327 is a partial cross-sectional side view of the clip applier ofFIG. 326 ;

FIG. 328 is a perspective view of the clip applier of FIG. 326 ;

FIG. 329 is a perspective view of a clip including a flexible base;

FIG. 330 is a side view of the clip of FIG. 329 in variousconfigurations;

FIG. 331 is a perspective view of a clip for use with a clip applier;

FIG. 332 is a side view of the clip of FIG. 331 in a storageconfiguration;

FIG. 333 is a side view of the clip of FIG. 331 in a pre-firingconfiguration;

FIG. 334 is a side view of the clip of FIG. 331 in a post-firingconfiguration;

FIG. 335 is a perspective view of a clip applier including a rotatableclip magazine;

FIG. 336 is a partial cross-sectional view of the clip applier of FIG.335 illustrating a closure tube of the clip applier in a fully retractedposition;

FIG. 337 is a partial cross-sectional view of the clip applier of FIG.335 illustrating the closure tube in a home position;

FIG. 338 is a perspective view of a ground portion including a clockingportion of the clip applier of FIG. 335 ;

FIG. 339 is a partial cross-sectional view of the clip applier of FIG.335 illustrating clips stored in the rotatable clip magazine prior tobeing advanced, illustrated with some components removed;

FIG. 340 is a partial cross-sectional view of the clip applier of FIG.335 illustrating a clip being advanced from the rotatable clip magazineby a feeder member of the clip applier;

FIG. 341 is a partial cross-sectional view of the clip applier of FIG.335 illustrating the feeder member retracted;

FIG. 342 is a partial cross-sectional view of the clip applier for FIG.335 illustrating a closure tube of the clip applier in a fully retractedposition;

FIG. 343 is a partial cross-sectional view of the clip applier of FIG.335 illustrating the closure tube in a home position and a firing memberadvancing a clip, illustrated with some components removed;

FIG. 344 is a partial cross-sectional view of the clip applier of FIG.336 illustrating the firing member retracted and the closure tube in afully advanced position, illustrated with some components removed;

FIG. 345 is a partial cross-sectional view of a clip applier comprisinga replaceable cartridge;

FIG. 346 is a cross-sectional end view of a rotatable clip magazine;

FIG. 347 is a plan view of a clip for use with the rotatable clipmagazine of FIG. 346 ;

FIG. 348 is a perspective view of a releasable clip cartridge includingan articulation joint;

FIG. 349 is a partial cross-sectional view of the releasable clipcartridge and articulation joint of FIG. 348 ;

FIG. 350 is a perspective view of a clip applier including anarticulation joint;

FIG. 351 is a partial cross-sectional view of a clip applier jawassembly;

FIG. 352 is a partial cross-sectional view of clip applier jaw assemblyincluding offset support legs;

FIG. 353 is a partial cross-sectional view of the clip applier jawassembly of FIG. 352 ;

FIG. 354 is a partial cross sectional plan view of the clip applier jawassembly of FIG. 351 ;

FIG. 355 is a partial cross sectional plan view of the clip applier jawassembly of FIG. 352 ;

FIG. 356 is a graphical depiction of the movements of a cam member and afeeder shoe of a clip applier throughout the operation of the clipapplier;

FIG. 357 is a graph depicting the displacement of a cam member andfeeder shoe of the clip applier of FIG. 335 as a function of time;

FIG. 358 depicts a first graph illustrating the force to advance a clipof a clip applier as a function of displacement and a second graphillustrating the voltage of a motor of the clip applier as a function oftime;

FIG. 359 depicts a graph of the force applied to a pair of jaws of aclip applier versus time;

FIG. 360 is directed to an alternative embodiment;

FIG. 361 is directed to an alternative embodiment;

FIG. 362 is a perspective view of a clip applier including a rotatingclip magazine, a magnet, and a Hall Effect sensor;

FIG. 363 is a graphical depiction of the clip applier of FIG. 362illustrating the voltage of the Hall Effect sensor as a function of theposition of the magnet over time;

FIG. 364 is a partial cross-sectional view of a clip applier includingresistive sensing circuits;

FIG. 365 is a partial cross-sectional view of a clip applier including avariable resistance meter;

FIG. 366 is a partial cross-sectional view of the clip applier of FIG.365 in a partially crimped configuration;

FIG. 367 is a perspective view of a clip applier jaw including straingauges;

FIG. 368 is a graphical depiction of the clip applier jaw of FIG. 367illustrating the voltage of the strain gauges as a function of time;

FIG. 369 is a partial cross-sectional view of a clip applier including asensor array and a magnet;

FIG. 370 is a partial cross-sectional view of the clip applier of FIG.369 ;

FIG. 371 is a perspective view of a clip applier system utilizing atrocar;

FIG. 372 is a perspective view of the clip applier system of FIG. 371 ;

FIG. 373 is a partial side elevation view of the clip applier system ofFIG. 371 depicting a jaw wing of a clip applier of the clip appliersystem positioned distal to a loading arm of a clip magazine of the clipapplier system;

FIG. 374 is a partial side elevation view of the clip applier system ofFIG. 371 depicting the jaw wing of the clip applier positioned proximalto the loading arm of the clip magazine;

FIG. 375 is a partial side elevation view of the clip applier system ofFIG. 371 depicting the jaw wing of the clip applier positioned proximalto the loading arm of the clip magazine;

FIG. 376 is a partial perspective view of the clip applier system ofFIG. 371 ;

FIG. 377 is a cross-sectional perspective view of the clip appliersystem of FIG. 371 ;

FIG. 378 is a plan view of the clip applier system of FIG. 371 depictinga jaw wing of the clip applier in an expanded configuration;

FIG. 379 is a plan view of the clip applier system of FIG. 371 depictingthe jaw wing of the clip applier in a retracted configuration;

FIG. 380 is a perspective view of a clip applier and a clip magazine foruse with the clip applier;

FIG. 381 is a perspective view of the clip magazine seated into the clipapplier of FIG. 380 ;

FIG. 382 is a perspective view of the clip applier and the clip magazineof FIG. 380 in a loaded configuration;

FIG. 383 is a cross-sectional view of the clip applier and the clipmagazine of FIG. 380 in the loaded configuration of FIG. 382 ;

FIG. 384 is a perspective view the spent clip magazine removed from theclip applier of FIG. 380 ;

FIG. 385 is a plan view of the spent clip magazine seated into the clipapplier of FIG. 380 ;

FIG. 386 is a cross-sectional plan view of the clip applier and the clipmagazine of FIG. 380 ;

FIG. 387 is a cross-sectional plan view of the clip applier and the clipmagazine of FIG. 380 in a nearly spent configuration;

FIG. 388 is a side elevational view of a clip applier utilizing aninterchangeable clip magazine;

FIG. 389 is a side elevational view of a distal head releasably attachedto a shaft of a clip applier;

FIG. 390 is a front elevational view of the distal head and shaft ofFIG. 389 ;

FIG. 391 is a side elevational view of a distal head releasably attachedto a shaft of a clip applier;

FIG. 392 is a front elevational view of the distal head and shaft ofFIG. 391

FIG. 393 is a side elevational view of a distal head releasably attachedto a shaft of a clip applier;

FIG. 394 is a front elevational view of the distal head and shaft ofFIG. 393 ;

FIG. 395 is an exploded perspective view of a clip applier systemcomprising interchangeable distal heads that are releasably attachableto a clip applier;

FIG. 396 is a cross-sectional view of a quick disconnect configured foruse between a shaft and a distal head of a clip applier;

FIG. 397 is a cross-sectional view of the quick disconnect of FIG. 396 ;

FIG. 398 is a cross-sectional front view of the quick disconnect of FIG.396 ;

FIG. 399 is a cross-sectional view of a clip magazine including clipsthat are stacked in an offset manner;

FIG. 400 is a cross-sectional view of a clip magazine including anopening for an internal drive of a clip applier;

FIG. 401 is a cross-sectional view of a clip magazine comprising slantedclip channels and an opening for an internal drive of a clip applier;

FIG. 402 is a cross-sectional view of a clip magazine for use with aclip applier;

FIG. 403 is a cross-sectional view of a clip magazine for use with aclip applier;

FIG. 404 is a cross-sectional view of a clip magazine comprising clipsstacked in a non-concentric radial array;

FIG. 405 is a perspective view of a clip magazine comprising an angledclip storage channel;

FIG. 406 is a cross-sectional view of a clip magazine including aplurality of clips and a lockout, illustrated with the clip magazine ina firing position;

FIG. 407 is a cross-sectional side elevation view of the clip magazineof FIG. 406 ;

FIG. 408 is a cross-sectional view of the clip magazine of FIG. 406which has been rotated counter clock-wise approximately 30 degrees fromthe firing position of FIG. 406 toward a clip loading position;

FIG. 409 is a cross-sectional view of the clip magazine of FIG. 406which has been rotated counter clock-wise approximately 60 degrees fromthe firing position of FIG. 406 toward the clip loading position;

FIG. 410 is a cross-sectional view of the clip magazine of FIG. 406 inthe clip loading position, wherein a clip is positioned in a loadingslot;

FIG. 411 is a cross-section view of the clip magazine of FIG. 406 in theclip loading position, wherein a lockout clip is positioned in theloading slot;

FIG. 412 is a perspective view of a clip applier comprising a clipmagazine and a rotary input, illustrated with the clip magazine is in aproximal position;

FIG. 413 is a perspective view of the clip applier of FIG. 412 ,illustrated with the clip magazine is in a distal position;

FIG. 414 is a perspective view of the clip applier of FIG. 412 ,illustrated with the clip magazine is in the distal position and hasrotated approximately 120 degrees;

FIG. 415 is a perspective view of the clip applier of FIG. 412 includinga feeder shoe, a crimping drive, and a shaft comprising a loading slot,wherein the loading slot has a clip from the clip magazine storedtherein;

FIG. 416 is a perspective exploded view of the clip applier of FIG. 415;

FIG. 417 is a cross-sectional view of a rotary input and a clip magazinefor use with a clip applier, wherein the rotary input is amulti-directional rotary input;

FIG. 418 is a cross-sectional side view of a rotary input and a clipmagazine for use with a clip applier, wherein the rotary input is amulti-directional rotary input;

FIG. 419 is a cross-sectional front view of the rotary input and clipmagazine of FIG. 418 ;

FIG. 420 is a cross-sectional view of a rotary input and a clip magazinefor use with a clip applier, wherein the rotary input is asingle-direction rotary input;

FIG. 421 is a cross-sectional view of a rotary input, a clip magazine,and a loading slot for use with a clip applier, wherein the rotary inputis a single-direction rotary input;

FIG. 422 is a perspective view of a rotary input and a clip magazine foruse with a clip applier, wherein the clip magazine includes a clam-shellconstruction;

FIG. 423 is a cross-sectional front view of the clip magazine of FIG.422 ;

FIG. 424 is an exploded perspective view of a clip applier comprising aclip magazine and a magazine driver, wherein the clip magazine andmagazine driver comprise camming surfaces;

FIG. 425 is a side elevational view of the clip applier of FIG. 424 ,illustrated with the clip magazine in a proximal position;

FIG. 426 is a side elevational view of the rotatable clip magazine ofFIG. 424 wherein the cam advancer has advanced the rotatable clipmagazine from the proximal position to a distal position;

FIG. 427 is a side elevational view of the rotatable clip magazine ofFIG. 424 in a ready to clock position relative to the cam advancer ofFIG. 424 ;

FIG. 428 is a graphical depiction of the absolute rotary position of themagazine driver of the clip applier of FIG. 424 during an operationsequence;

FIG. 429 is a cross-sectional view of a clip applier comprising an endeffector, a clip magazine, a clip carriage, and a clip former configuredto form a clip from the clip magazine;

FIG. 430 is a cross-sectional view of the clip applier of FIG. 429depicting the clip carriage holding a clip with portions of the clipapplier removed for the purpose of illustration;

FIG. 431 is a cross-sectional view of the clip applier of FIG. 429depicting the clip carriage advancing a clip into a staging positionwith portions of the clip applier removed for the purpose ofillustration;

FIG. 432 is a cross-sectional view of the clip applier of FIG. 429depicting the clip carriage retracted and a clip in the staging positionwith portions of the clip applier removed for the purpose ofillustration;

FIG. 433 is a cross-sectional view of the clip applier of FIG. 429depicting the clip carriage advancing a clip in the staging positioninto the end effector with portions of the clip applier removed for thepurpose of illustration;

FIG. 434 is a cross-sectional view of the clip applier of FIG. 429depicting the clip carriage retracted a clip to a forming position,wherein the an anvil is positioned above the clip;

FIG. 435 is a cross-sectional view of the clip applier of FIG. 429depicting the clip carriage retracted a clip to the forming position,wherein the an anvil is positioned in between a first leg and a secondleg of the clip;

FIG. 436 is a plan view of the clip carriage and anvil of the clipapplier of FIG. 429 , wherein a clip has been positioned around theanvil, and wherein the clip is in an unformed state;

FIG. 437 is a plan view of the clip carriage and anvil of the clipapplier of FIG. 429 , wherein a clip has been positioned around theanvil, and wherein the clip is in a formed state;

FIG. 438 is a cross-sectional view of the clip applier of FIG. 429 ;

FIG. 439 is a perspective view of a clip applier comprising an endeffector, a clip magazine, and co-axial rotary inputs comprised ofdual-woven cables;

FIG. 440 is a perspective view of a clip applier comprising an endeffector, a clip magazine, and co-axial rotary inputs comprises of wiretubing;

FIG. 441 is a perspective view of rotary input for use with a clipapplier, wherein the rotary input comprises layers of coiled springswound in opposite directions;

FIG. 442 is a perspective view of a clip applier comprising a shaft, aclip magazine, and a clip advancer configured to advance clips from theclip magazine into a loading slot, then into a staging position, andthen into a clip track of the clip applier, wherein a first clip isshown in the clip magazine;

FIG. 443 is a perspective view of the clip applier of FIG. 442 depictingthe first clip being advanced into the loading slot of the clip applieras the clip magazine moves distally;

FIG. 444 is a perspective view of the clip applier of FIG. 442 depictingthe first clip being stripped from the clip magazine by the loading slotof the clip applier as the clip magazine is rotated and retracted;

FIG. 445 is a perspective view of the clip applier of FIG. 442 depictingthe first clip in the loading slot as the clip magazine is furtherrotated and retracted;

FIG. 446 is a perspective view of the clip applier of FIG. 442 depictingthe first clip in the loading slot as the clip magazine is fullyretracted placing the first clip in a position to be advanced throughthe loading slot;

FIG. 447 is a perspective view of the clip applier of FIG. 442 depictingthe first clip in the loading slot as the clip magazine is advanced toengage the clip advancer with the backside of the first clip;

FIG. 448 is a perspective view of the clip applier of FIG. 442 depictingthe first clip after it has been advanced through the loading slot bythe clip advancer;

FIG. 449 is a perspective view of the clip applier of FIG. 442 depictingthe first clip after it has been advanced out of the loading slot intothe staging position by the clip advancer;

FIG. 450 is a perspective view of the clip applier of FIG. 442 depictingthe first clip positioned in the staging position and the clip advancerand clip magazine retracted;

FIG. 451 is a perspective view of the clip applier of FIG. 442 depictingthe clip magazine and the clip advancer advanced and abutted against thefirst clip in the staging position;

FIG. 452 is a perspective view of the clip applier of FIG. 442 depictingthe first clip after it has been advanced from the staging position intothe clip track by the clip advancer;

FIG. 453 is a perspective view of the clip applier of FIG. 442 depictingthe first clip after it has been completely advanced into the clip trackby the clip advancer;

FIG. 454 is a perspective view of the clip applier of FIG. 442 depictingthe first clip after it has been advanced through the loading slot, witha second clip positioned in the loading slot and a third clip positionedin the clip magazine;

FIG. 455 is a perspective view of the clip applier of FIG. 442 depictingthe first clip in the clip track, the second clip in the stagingposition, and the third clip in the loading slot;

FIG. 456 is a perspective view of the clip applier of FIG. 442 depictingthe first clip in the clip track, the second clip in the stagingposition, the third clip in the loading slot, and a fourth clip in theclip magazine;

FIG. 457 is a perspective view of the clip applier of FIG. 442 depictingthe first clip in the clip track, the second clip in the clip track, thethird clip in the staging position, and a fourth clip in the loadingslot;

FIG. 458 is a perspective view of the clip applier of FIG. 442 depictingan end effector extending from the shaft of the clip applier, whereinthe first clip is in the clip track, the second clip is in the cliptrack, the third clip is in the staging position, a fourth clip is inthe loading slot, and a fifth clip is in the clip magazine.

FIG. 459 is a perspective view of the clip applier of FIG. 442 , whereinthe first, second, third, fourth, and fifth clips have been advancedtoward the end effector.

FIG. 460 is a perspective view of the clip applier of FIG. 442 , whereinthe first clip has been advanced into the end effector.

FIG. 461 is a perspective view of the clip applier of FIG. 442 depictinga jaw cam and feeder shoe mounted to the end effector.

FIG. 462 is a perspective view of the clip applier of FIG. 442 depictingthe feeder shoe engaged with the backside of the first clip and the jawcam in a proximal position.

FIG. 463 is a perspective view of an alternative embodiment of a jaw camfor use with the end effector of the clip applier of FIG. 442 ,illustrated with the jaw cam in a proximal position;

FIG. 464 is a perspective view of the alternative embodiment of FIG. 463, illustrated with the jaw cam in a distal position.

FIG. 465 is a perspective view of the alternative embodiment of FIG. 464, illustrated with the jaw cam in a closing position;

FIG. 466 is a perspective view of a clip applier comprising atranslatable clip magazine and a translatable and rotatable clipadvancer configured to advance a clip;

FIG. 467 is a plan view of the clip applier of FIG. 466 , illustratingthe clip magazine and clip advancer in proximal positions;

FIG. 468 is a plan view of the clip applier of FIG. 466 , illustratingthe clip magazine and clip advancer moved distally from their proximalpositions to advance the clip;

FIG. 469 is a plan view of the clip applier of FIG. 466 , illustratingthe clip magazine and clip advancer moved to their distal-most positionsto completely advance the clip;

FIG. 470 is a plan view of the clip applier of FIG. 466 , illustratingthe clip magazine and clip advancer partially retracted from theirdistal-most positions toward their proximal position;

FIG. 471 is a plan view of the clip applier of FIG. 466 , illustratingthe clip magazine and clip advancer in their proximal positions;

FIG. 472 is a side view of the clip applier of FIG. 466 , illustratingthe clip magazine and clip advancer in their proximal positions with theclip ready to be advanced;

FIG. 473 is a side view of the clip applier of FIG. 466 , illustratingthe clip magazine and clip advancer in their distal-most positions afteradvancing the clip;

FIG. 474 is a perspective view of a clip applier comprising an endeffector spanning two different planes, a clip magazine, and a rotaryinput extending through the clip magazine;

FIG. 475 is a cross-sectional view of the clip applier of FIG. 474depicting a portion of the end effector and the rotary input extendingthrough the clip magazine;

FIG. 476 is a cross-sectional view of the clip applier of FIG. 474depicting an anchor portion of the end effector extending through theclip magazine;

FIG. 477 is a cross-sectional view of the clip applier of FIG. 474depicting a portion of the end effector and the rotary input extendingthrough the clip magazine including clip holders;

FIG. 478 is a perspective view of a clip applier comprising an endeffector extending from a shaft, and a clip magazine, wherein the endeffector spans two different planes;

FIG. 479 is a side view of the clip applier of FIG. 478 ;

FIG. 480 is a perspective view of the clip applier of FIG. 478 depictinga collar of the clip applier being installed onto the end effector;

FIG. 481 is a perspective view of the clip applier of FIG. 156 depictingthe collar of the clip applier installed onto the end effector;

FIG. 482 is a perspective view of an end effector of an alternativeembodiment.

FIG. 483 is a side view of a clip applier comprising a drive screw withtwo different thread pitches configured to move a camming member and afeeder shoe in opposite directions to advance and crimp a clip,illustrating the camming member in a proximal position and the feedershoe in a distal position;

FIG. 484 is a side view of the clip applier of FIG. 483 , illustratingthe camming member in a distal position and the feeder shoe in aproximal position;

FIG. 485 is a plan view of a clip applier comprising an end effectorincluding jaws configured to close parallel to one another in responseto a rotation of a drive screw, illustrating the jaws in an openposition;

FIG. 486 is a plan view of the clip applier of FIG. 485 , illustratingthe jaws in a closed position;

FIG. 487 is a plan view of a clip applier comprising an end effectorincluding jaws configured to provide tip first closure in response to arotation of a drive screw, illustrating the jaws in an open position;

FIG. 488 is a plan view of the clip applier of FIG. 487 , illustratingthe jaws in a closed position;

FIG. 489 is a side elevational view of a clip applier comprising a jawcam and a clip advancer, wherein the clip applier is configured toadvance a clip and approximate a pair of jaws in response to the samerotary input, illustrating the jaw cam in a distal position and the jawsin a closed configuration;

FIG. 490 is a side elevational view of the clip applier of FIG. 489 ,illustrating the pair of jaws in an open configuration and the jaw camretracted to a proximal position;

FIG. 491 is a side elevational view of the clip applier of FIG. 489 ,illustrating the pair of jaws in the open configuration and the jaw camretracted to a fully-retracted position to release the clip advancer andto advance a clip into the pair of jaws;

FIG. 492 is a side elevational view of the clip applier of FIG. 489 ,wherein a shoe retrieval latch of the jaw cam is operably engaged withthe clip advancer when the jaw cam is advanced again to the distalposition;

FIG. 493 is a perspective view of the jaw cam and the shoe retrievallatch of the clip applier of FIG. 489 ;

FIG. 494 is a perspective view of the jaw cam and the shoe retrievallatch of the clip applier of FIG. 489 engaging a feeder shoe of the clipadvancer;

FIG. 495 is a perspective view of a clip applier comprising a cam memberand a clip advancer threadably engaged with a rotary input andconfigured to advance a clip and approximate a pair of opposing jaws,wherein the cam member and clip advancer are in a proximal position andthe pair of jaws are closed;

FIG. 496 is a perspective view of the clip applier of FIG. 495 , whereinthe cam member and clip advancer are in an intermediate position and thepair of jaws are open;

FIG. 497 is a perspective view of the clip applier of FIG. 495 , whereinthe cam member and clip advancer are in a distal position, the pair ofjaws are open, and a clip has been advanced into the pair of jaws;

FIG. 498 is a cross-sectional side view of the clip applier of FIG. 495, wherein the cam member and clip advancer are in the proximal positionand the pair of jaws are closed;

FIG. 499 is a cross-sectional side view of the clip applier of FIG. 495, wherein the cam member and clip advancer are in the intermediateposition and the pair of jaws are open;

FIG. 500 is a cross-sectional side view of the clip applier of FIG. 495, wherein the cam member and clip advancer are in the distal position,the pair of jaws are open, and the clip has been advanced into the pairof jaws;

FIG. 501 is a graphical depiction of a clip applier illustratingposition of a crimping drive of the clip applier over time and includingset points indicative of clip formation;

FIG. 502 is a schematic of a control system for use with any of thesurgical instruments disclosed herein;

FIG. 503 illustrates a surgical system comprising a handle and severalshaft assemblies—each of which are selectively attachable to the handlein accordance with at least one embodiment;

FIG. 504 is an elevational view of the handle and one of the shaftassemblies of the surgical system of FIG. 503 ;

FIG. 505 is a partial cross-sectional perspective view of the shaftassembly of FIG. 504 ;

FIG. 506 is another partial cross-sectional perspective view of theshaft assembly of FIG. 504 ;

FIG. 507 is a partial exploded view of the shaft assembly of FIG. 504 ;

FIG. 508 is a partial cross-sectional elevational view of the shaftassembly of FIG. 504 ;

FIG. 509 is an elevational view of a drive module of the handle of FIG.503 ;

FIG. 510 is a cross-sectional perspective view of the drive module ofFIG. 509 ;

FIG. 511 is an end view of the drive module of FIG. 509 ;

FIG. 512 is a partial cross-sectional view of the interconnectionbetween the handle and shaft assembly of FIG. 504 in a lockedconfiguration;

FIG. 513 is a partial cross-sectional view of the interconnectionbetween the handle and shaft assembly of FIG. 504 in an unlockedconfiguration;

FIG. 514 is a cross-sectional perspective view of a motor and a speedreduction gear assembly of the drive module of FIG. 519 ;

FIG. 515 is an end view of the speed reduction gear assembly of FIG. 514;

FIG. 516 is a partial perspective view of an end effector of the shaftassembly of FIG. 504 in an open configuration;

FIG. 517 is a partial perspective view of the end effector of FIG. 516in a closed configuration;

FIG. 518 is a partial perspective view of the end effector of FIG. 516articulated in a first direction;

FIG. 519 is a partial perspective view of the end effector of FIG. 516articulated in a second direction;

FIG. 520 is a partial perspective view of the end effector of FIG. 516rotated in a first direction;

FIG. 521 is a partial perspective view of the end effector of FIG. 516rotated in a second direction;

FIG. 522 is a partial cross-sectional perspective view of the endeffector of FIG. 516 detached from the shaft assembly of FIG. 504 ;

FIG. 523 is an exploded view of the end effector of FIG. 516 illustratedwith some components removed;

FIG. 524 is an exploded view of a distal attachment portion of the shaftassembly of FIG. 504 ;

FIG. 525 is an exploded view of the distal portion of the shaft assemblyof FIG. 504 illustrated with some components removed;

FIG. 526 is another partial cross-sectional perspective view of the endeffector of FIG. 516 detached from the shaft assembly of FIG. 504 ;

FIG. 527 is a partial cross-sectional perspective view of the endeffector of FIG. 516 attached to the shaft assembly of FIG. 504 ;

FIG. 528 is a partial cross-sectional perspective view of the endeffector of FIG. 516 attached to the shaft assembly of FIG. 504 ;

FIG. 529 is another partial cross-sectional perspective view of the endeffector of FIG. 516 attached to the shaft assembly of FIG. 504 ;

FIG. 530 is a partial cross-sectional view of the end effector of FIG.516 attached to the shaft assembly of FIG. 504 depicting a first,second, and third clutch of the end effector;

FIG. 531 depicts the first clutch of FIG. 530 in an unactuatedcondition;

FIG. 532 depicts the first clutch of FIG. 530 in an actuated condition;

FIG. 533 depicts the second clutch of FIG. 530 in an unactuatedcondition;

FIG. 534 depicts the second clutch of FIG. 530 in an actuated condition;

FIG. 535 depicts the third clutch of FIG. 530 in an unactuatedcondition;

FIG. 536 depicts the third clutch of FIG. 530 in an actuated condition;

FIG. 537 depicts the second and third clutches of FIG. 530 in theirunactuated conditions and the end effector of FIG. 516 locked to theshaft assembly of FIG. 504 ;

FIG. 538 depicts the second clutch of FIG. 530 in its unactuatedcondition and the third clutch of FIG. 530 in its actuated condition;

FIG. 539 depicts the second and third clutches of FIG. 530 in theiractuated conditions and the end effector of FIG. 516 unlocked from theshaft assembly of FIG. 504 ;

FIG. 540 is a partial cross-sectional view of a shaft assembly inaccordance with at least one alternative embodiment comprising sensorsconfigured to detect the conditions of the first, second, and thirdclutches of FIG. 530 ;

FIG. 541 is a partial cross-sectional view of a shaft assembly inaccordance with at least one alternative embodiment comprising sensorsconfigured to detect the conditions of the first, second, and thirdclutches of FIG. 530 ;

FIG. 542 depicts the first and second clutches of FIG. 541 in theirunactuated conditions and a sensor in accordance with at least onealternative embodiment;

FIG. 543 depicts the second and third clutches of FIG. 541 in theirunactuated conditions and a sensor in accordance with at least onealternative embodiment;

FIG. 544 is a partial cross-sectional view of a shaft assembly inaccordance with at least one embodiment;

FIG. 545 is a partial cross-sectional view of the shaft assembly of FIG.544 comprising a clutch illustrated in an unactuated condition;

FIG. 546 is a partial cross-sectional view of the shaft assembly of FIG.544 illustrating the clutch in an actuated condition;

FIG. 547 is a partial cross-sectional view of a shaft assembly inaccordance with at least one embodiment comprising first and secondclutches illustrated in an unactuated condition;

FIG. 548 is a perspective view of the handle drive module of FIG. 509and one of the shaft assemblies of the surgical system of FIG. 503 ;

FIG. 549 is another perspective view of the handle drive module of FIG.509 and the shaft assembly of FIG. 548 ;

FIG. 550 is a partial cross-sectional view of the shaft assembly of FIG.548 attached to the handle of FIG. 503 ;

FIG. 551 is another partial cross-sectional view of the shaft assemblyof FIG. 548 attached to the handle of FIG. 503 ;

FIG. 552 is a partial cross-sectional perspective view of the shaftassembly of FIG. 548 ;

FIG. 553 is a schematic of the control system of the surgical system ofFIG. 503 ;

FIG. 554 is an elevational view of the handle and one of the shaftassemblies of the surgical system of FIG. 503 ;

FIG. 555 is a perspective view of the handle of FIG. 503 and the shaftassembly of FIG. 504 ;

FIG. 556 is a partial top plan view of the handle of FIG. 503 and theshaft assembly of FIG. 504 ;

FIG. 557 is a partial elevational view of the handle of FIG. 503 and theshaft assembly of FIG. 504 ;

FIG. 558 is a perspective view of the drive module of FIG. 509 and apower module of FIG. 503 ;

FIG. 559 is a perspective view of the drive module of FIG. 509 and thepower module of FIG. 558 ;

FIG. 560 is an elevational view of the drive module of FIG. 509 and thepower module of FIG. 558 attached to a side battery port of the drivemodule;

FIG. 561 is a partial cross-sectional view of the connection between theside battery port of the drive module of FIG. 509 and the power moduleof FIG. 558 ;

FIG. 562 is an elevational view of the handle drive module of FIG. 509 ,the power module of FIG. 548 attached to a proximal battery port of thehandle drive module, and the shaft assembly of FIG. 548 attached to thedrive module;

FIG. 563 is a top view of the drive module of FIG. 509 and the powermodule of FIG. 548 attached to the proximal battery port;

FIG. 564 is an elevational view of the drive module of FIG. 509 and thepower module of FIG. 548 attached to the proximal battery port;

FIG. 565 is a perspective view of the drive module of FIG. 509 and thepower module of FIG. 548 attached to the proximal battery port;

FIG. 566 is a perspective view of the power module of FIG. 548 detachedfrom the drive module of FIG. 509 ;

FIG. 567 is another perspective view of the power module of FIG. 548detached from the drive module of FIG. 509 ;

FIG. 568 is an elevational view of the power module of FIG. 548 attachedto the proximal battery port of the drive module of FIG. 509 ;

FIG. 569 is a partial cross-sectional view of the connection betweenproximal battery port of the drive module of FIG. 509 and the powermodule of FIG. 548 ;

FIG. 570 is an elevational view of the power module of FIG. 558 attachedto the proximal battery port of the drive module of FIG. 509 ;

FIG. 571 is a partial cross-sectional view of the connection between theproximal battery port of the drive module of FIG. 509 and the powermodule of FIG. 558 ;

FIG. 572 is an elevational view of an attempt to connect the powermodule of FIG. 548 to the side battery port of the drive module of FIG.509 ;

FIG. 573 is a cross-sectional detail view of an attempt to connect thepower module of FIG. 548 to the side battery port of the drive module ofFIG. 509 ;

FIG. 574 is a perspective view of the power module of FIG. 548 attachedto the proximal battery port of the drive module of FIG. 509 and thepower module of FIG. 558 attached to the side battery port;

FIG. 575 is a cross-sectional view of the power module of FIG. 548attached to the proximal battery port of the drive module of FIG. 509and the power module of FIG. 558 attached to the side battery port;

FIG. 576 is a perspective view of a portion of a surgical instrumentcomprising selectively attachable modular components in accordance withat least one aspect of the present disclosure;

FIG. 577 illustrates an electrical architecture of the surgicalinstrument of FIG. 576 in accordance with at least one aspect of thepresent disclosure;

FIG. 578 is a partial cross-sectional perspective view of a handle ofthe surgical instrument of FIG. 576 in accordance with at least oneaspect of the present disclosure;

FIG. 579 is a perspective view of a system of magnetic elements arrangedon the handle and a shaft of the surgical instrument of FIG. 576 inaccordance with at least one aspect of the present disclosure;

FIG. 580 is a perspective view of a system of magnetic elements arrangedon the handle and the shaft of the surgical instrument of FIG. 576 inaccordance with at least one aspect of the present disclosure;

FIG. 581 is a perspective view of the system of magnetic elements ofFIG. 580 aligning the shaft with the handle of the surgical instrumentin accordance with at least one aspect of the present disclosure;

FIG. 582 is a perspective view of a flex circuit for use in the surgicalinstrument of FIG. 576 in accordance with at least one aspect of thepresent disclosure;

FIG. 583 is a detail perspective view of a primary strain relief portionof the flex circuit of FIG. 582 in accordance with at least one aspectof the present disclosure;

FIG. 584 is a detail perspective view of a secondary strain reliefportion of the flex circuit of FIG. 582 in accordance with at least oneaspect of the present disclosure;

FIG. 585 is a detail perspective view of control circuit componentsincorporated into a flexible plastic of the flex circuit of FIG. 582 inaccordance with at least one aspect of the present disclosure;

FIG. 586 is a perspective view of a flex circuit for use in combinationwith the flex circuit of FIG. 582 in accordance with at least one aspectof the present disclosure;

FIG. 587 is a perspective view of the flex circuit of FIG. 582 prior tobeing electrically coupled with the flex circuit of FIG. 586 inaccordance with at least one aspect of the present disclosure;

FIG. 588 is a perspective view of the flex circuit of FIG. 582electrically coupled to the flex circuit of FIG. 586 in accordance withat least one aspect of the present disclosure;

FIG. 589 is an elevational view of a surgical instrument in accordancewith at least one embodiment;

FIG. 590 is a partial detail view of the surgical instrument of FIG. 589;

FIG. 591 is a partial detail view of the surgical instrument of FIG. 589illustrating a probe inserted into a handle of the surgical instrument;

FIG. 592 is a perspective view of a trocar in accordance with at leastone embodiment configured to facilitate the insertion of the surgicalinstrument of FIG. 589 , for example, into a patient;

FIG. 593 is a perspective view of a drive system of the surgicalinstrument of FIG. 589 ;

FIG. 594 is a perspective view of a drive system in accordance with atleast one embodiment;

FIG. 595 is a perspective view of a strain gage of the surgicalinstrument of FIG. 589 ;

FIG. 596 depicts the strain gage of FIG. 595 in an elongated condition;

FIG. 597 depicts the strain gage of FIG. 595 in a contracted condition;

FIG. 598 illustrates a Wheatstone bridge comprising a strain gage inaccordance with at least one embodiment;

FIG. 599 is a perspective view of one half of a handle housing of thesurgical instrument of FIG. 589 ;

FIG. 600 is a partial perspective view of circuit boards in the handleof FIG. 599 ;

FIG. 601 is a partial cross-sectional view of a surgical instrument inaccordance with at least one embodiment;

FIG. 602 is a partial detail view of an electrical interface within thesurgical instrument of FIG. 601 ;

FIG. 603 is a perspective view of a handle in accordance with at leastone embodiment;

FIG. 604 is a perspective view of a button shell of the handle of FIG.603 ;

FIG. 605 is a perspective view of another button shell of the handle ofFIG. 603 ;

FIG. 606 is a perspective view of another button shell of the handle ofFIG. 603 ;

FIG. 607 is a cross-sectional view of a button shell in accordance withat least one embodiment;

FIG. 608 is a cross-sectional view of a button shell in accordance withat least one embodiment;

FIG. 609 is a perspective view of a surgical instrument handle inaccordance with at least one embodiment;

FIG. 610 is a perspective view of a surgical instrument handle inaccordance with at least one embodiment;

FIG. 611 is a perspective view of a surgical instrument handle inaccordance with at least one embodiment;

FIG. 612 is an icon displayable on a surgical instrument in accordancewith at least one embodiment;

FIG. 613 is an icon displayable on a surgical instrument in accordancewith at least one embodiment;

FIG. 614 is an icon displayable on a surgical instrument in accordancewith at least one embodiment;

FIG. 615 illustrates a handle flexible circuit and a shaft flexiblecircuit of a surgical instrument, in accordance with at least oneembodiment;

FIG. 616 illustrates a connection between the handle flexible circuitand the shaft flexible circuit of FIG. 615 ;

FIG. 617 illustrates a control circuit of a surgical instrument, inaccordance with at least one embodiment;

FIG. 618 illustrates timing diagrams associated with the control circuitof FIG. 617 , in accordance with at least one embodiment;

FIG. 619 illustrates a control circuit of a surgical instrument, inaccordance with at least one embodiment;

FIG. 620 illustrates a control circuit configured to indicate the powerbeing delivered to an electric motor, in accordance with at least oneembodiment;

FIG. 621 illustrates a graduated display in communication with thecontrol circuit of FIG. 620 , in accordance with at least oneembodiment;

FIG. 622 illustrates a surgical instrument comprising a handle, inaccordance with at least one embodiment;

FIG. 623 illustrates a surgical system, in accordance with at least oneembodiment;

FIG. 624 illustrates a schematic diagram representative of current andsignal paths of the surgical system of FIG. 623 , in accordance with atleast one embodiment;

FIG. 625 illustrates a graph showing a relationship between a continuitylevel of a patient and a level of electrosurgical power supplied by thesurgical system of FIG. 623 , in accordance with at least oneembodiment;

FIG. 626 illustrates a flexible circuit of a surgical instrument, inaccordance with at least one embodiment;

FIG. 627 illustrates a cross-section of the flexible circuit of FIG. 626;

FIG. 628 illustrates a flexible circuit of a surgical instrument, inaccordance with at least one embodiment;

FIG. 629 illustrates a cross-section of the flexible circuit of FIG. 628;

FIG. 630 illustrates a flexible circuit of a surgical instrument, inaccordance with at least one embodiment;

FIG. 631 illustrates a control circuit of a surgical instrument, inaccordance with at least one embodiment;

FIG. 632 illustrates a method for identifying a degradation or failureof components of a surgical instrument, in accordance with at least oneembodiment;

FIG. 633 illustrates a graph showing frequency component signals ofacoustical signatures of components of a surgical instrument, inaccordance with at least one embodiment;

FIG. 634 illustrates components associated with the frequency componentsignals of FIG. 633 ;

FIG. 635 illustrates a method for identifying a degradation or failureof drive components of a surgical instrument, in accordance with atleast one embodiment;

FIG. 636 illustrates a graph showing a relationship between motorcurrent draw and frequency component signals of the motor of a surgicalinstrument, in accordance with at least one embodiment;

FIG. 637 illustrates a method for adjusting a motor control algorithm ofa surgical instrument, in accordance with at least one embodiment;

FIG. 638 illustrates an environment of a surgical procedure, inaccordance with at least one embodiment;

FIG. 639 illustrates a monopolar surgical instrument, in accordance withat least one embodiment;

FIGS. 640 and 641 illustrate electrical terminations of the monopolarsurgical instrument of FIG. 639 ;

FIG. 642 illustrates a graph showing a relationship between leakagecurrent and distances between surgical instruments, in accordance withat least one aspect of the present disclosure;

FIG. 643 illustrates a graph showing direct current (DC) output voltagethresholds for different types of surgical instrument contact, inaccordance with at least one embodiment;

FIG. 644 illustrates a powered surgical instrument, in accordance withat least one embodiment;

FIG. 645 illustrates a graph showing electrical potential associatedwith the powered surgical instrument of FIG. 644 , in accordance with atleast one embodiment;

FIG. 646 illustrates an active transmission and sensing scheme utilizedby a surgical instrument, in accordance with at least one embodiment;

FIG. 647 illustrates a graph showing signals transmitted and received bythe surgical instrument of FIG. 646 ;

FIG. 648 illustrates a graph showing proximity measurements associatedwith the surgical instrument of FIG. 646 ;

FIG. 649 illustrates a passive sensing scheme utilized by a surgicalinstrument, in accordance with at least one embodiment;

FIG. 650 illustrates a primary magnetic field associated with thesurgical instrument of FIG. 649 in an unaffected condition;

FIG. 651 illustrates a primary magnetic field associated with thesurgical instrument of FIG. 649 in an affected condition;

FIG. 652 illustrates a graph which showing Hall current associated withthe surgical instrument of FIG. 649 , in accordance with at least oneembodiment;

FIGS. 653 and 654 illustrate a passive sensing scheme utilized by asurgical instrument, in accordance with at least one embodiment;

FIG. 655 illustrates a schematic of a surgical instrument, in accordancewith at least one embodiment;

FIG. 656 illustrates a graph which showing induced current measured by acurrent sensor of the surgical instrument of FIG. 655 , in accordancewith at least one embodiment;

FIG. 657 illustrates a surgical instrument in accordance with at leastone embodiment illustrated with components removed;

FIG. 658 illustrates an electrical circuit of the surgical instrument ofFIG. 657 ;

FIG. 659 illustrates a graph showing relationships between altitude,atmospheric pressure and electrical power utilized by a surgicalinstrument, in accordance with at least one embodiment;

FIG. 660 illustrates a method for predicting an occurrence of apredefined temperature threshold being exceeded, in accordance with atleast one embodiment;

FIG. 661 illustrates a graph showing a relationship between a sensedtemperature, an approximated temperature, and an energy usage of asurgical instrument, in accordance with at least one embodiment;

FIG. 662 is a perspective view of a surgical suturing instrumentcomprising a handle, a shaft, and an end effector;

FIG. 663 is a partial plan view of the surgical suturing instrument ofFIG. 662 ;

FIG. 664 is a partial plan view of the surgical suturing instrument ofFIG. 662 , wherein the end effector is in an articulated state;

FIG. 665 is a partial perspective view of the surgical suturinginstrument of FIG. 662 ;

FIG. 666 is a partial perspective view of the surgical suturinginstrument of FIG. 662 , wherein the end effector is in an articulatedand rotated state;

FIG. 667 is a schematic of a needle sensing system and a circuit diagramof a needle sensing circuit of the needle sensing system, wherein aneedle of the needle sensing system is in a home position;

FIG. 668 is a schematic of the needle sensing system of FIG. 667 and acircuit diagram of the needle sensing circuit of FIG. 667 , wherein theneedle is in a first partially fired position;

FIG. 669 is a schematic of the needle sensing system of FIG. 667 and acircuit diagram of the needle sensing circuit of FIG. 667 , wherein theneedle is in a second partially fired position;

FIG. 670 is a logic diagram of a process depicting a control program forcontrolling a surgical suturing instrument;

FIG. 671 is a plan view of a suturing device cartridge comprising anadaptive needle driving system;

FIG. 672 is a graph of a first aspect of an adaptive needle drivingsystem;

FIG. 673 is a graph of a second aspect of the adaptive needle drivingsystem of FIG. 672 ;

FIG. 674 is a graph of a third aspect of the adaptive needle drivingsystem of FIG. 672 ;

FIG. 675 is a plan view of a collapsible suturing device comprising ashaft and a needle driving system, wherein the needle driving systemcomprises a movable needle guide, and wherein the movable needle guideis in an expanded position;

FIG. 676 is a plan view of the suturing device of FIG. 675 , wherein themovable needle guide is in a collapsed position;

FIG. 677 is a plan view of the suturing device of FIG. 675 , wherein themovable needle guide is in a partially expanded position;

FIG. 678 is a plan view of a collapsible suturing device comprising ashaft and an end effector configured to be articulated relative to theshaft, wherein the end effector comprises a needle driving systemcomprising a movable needle guide;

FIG. 679 is a plan view of a collapsible suturing device comprising aneedle driving system comprising a movable needle guide and anintermediate feed wheel;

FIG. 680 is a cross-sectional view of an end effector of a suturingdevice comprising a body portion, a needle track defined within the bodyportion, and a suturing needle, wherein the suturing needle is in aparked position;

FIG. 681 is a cross-sectional view of the end effector of FIG. 680 ,wherein the suturing needle is in a ready-to-fire position;

FIG. 682 is a cross-sectional view of the end effector of FIG. 680 ,wherein the suturing needle is in a partially-fired position;

FIG. 683 is a diagram illustrating a relationship between stress andstrain of a component of an end effector and corresponding identifiableevents during the use of the end effector;

FIG. 684 is a partial perspective view of a surgical instrument systemcomprising an actuation interface and a modular shaft to be actuatedwith the actuation interface, wherein the surgical instrument system isshown in a partially attached configuration;

FIG. 685 is a graph illustrating a sensed torque of the surgicalinstrument system of FIG. 684 and a sensed current of a motor of thesurgical instrument system of FIG. 684 ;

FIG. 686 is a partial perspective view of a surgical grasper and amono-polar bridge instrument;

FIG. 687 is a graph illustrating a reactive algorithm of the surgicalgrasper of FIG. 686 ;

FIG. 688 is a logic diagram of a process depicting a control program forcontrolling a surgical instrument;

FIG. 689 is a partial perspective view of a surgical suturinginstrument; and

FIG. 690 is a graph depicting sensed parameters of the surgical suturinginstrument of FIG. 689 and also depicting an algorithm for the surgicalsuturing instrument to react to the sensed parameters.

FIG. 691 is a logic diagram of a process depicting a control program forcontrolling a surgical suturing instrument;

FIG. 692 is a perspective view of an end effector assembly comprising asuture cartridge;

FIG. 693 is a partial perspective view of the end effector assembly ofFIG. 692 ;

FIG. 694 is a partial cross-sectional view of an end effector assemblycomprising a needle sensing system;

FIG. 695 is a partial perspective view of an end effector assemblycomprising a needle sensing system;

FIG. 696 is a partial perspective view of an end effector assemblycomprising a needle sensing system;

FIG. 697 is a partial perspective view of an end effector assemblycomprising a needle sensing system;

FIG. 698 is a partial perspective view of an end effector assemblycomprising a needle sensing system;

FIG. 699 is a perspective view of a helical suturing needle for use witha surgical suturing instrument;

FIG. 700 is an elevational view of the helical suturing needle of FIG.699 ;

FIG. 701 is a logic flow diagram of a process depicting a controlprogram for controlling a surgical instrument;

FIG. 702 is a perspective view of a surgical suturing instrument handlecomprising a motor;

FIG. 703 is a partial cross-sectional view of the surgical suturinginstrument handle of FIG. 702 ;

FIG. 704 is an exploded view of a suturing cartridge for use with asurgical suturing system;

FIG. 705 is a partial cross-sectional view of a surgical instrumentincluding a jaw assembly capable of grasping and dissection inaccordance with at least one embodiment;

FIG. 706 is a graph depicting the force, speed, and orientation of thejaw assembly of FIG. 705 in accordance with at least one embodiment;

FIG. 707 is a partial perspective view of bipolar forceps being used tocut tissue;

FIG. 708 is a perspective view of the bipolar forceps of FIG. 707 ;

FIG. 709 is a graph depicting the force and speed of the jaws of thebipolar forceps of FIG. 707 in accordance with at least one embodiment;

FIG. 710 is another graph depicting the operation of the bipolar forcepsof FIG. 707 in accordance with at least one embodiment;

FIG. 711 is a schematic of a control system for use with any of thesurgical instruments disclosed herein;

FIG. 712 illustrates a surgical instrument system comprising a handleand several shaft assemblies—each of which are selectively attachable tothe handle in accordance with at least one embodiment;

FIG. 713 is an elevational view of the handle and one of the shaftassemblies of the surgical instrument system of FIG. 712 ;

FIG. 714 is an elevational view of a drive module of the handle of FIG.712 ;

FIG. 715 is a cross-sectional perspective view of the drive module ofFIG. 714 ;

FIG. 716 is an end view of the drive module of FIG. 714 ;

FIG. 717 is a perspective view of the handle drive module of FIG. 714and one of the shaft assemblies of the surgical instrument system ofFIG. 712 ;

FIG. 718 is another perspective view of the handle drive module of FIG.712 and the shaft assembly of FIG. 717 ;

FIG. 719 is a partial cross-sectional perspective view of a handle drivemodule in accordance with at least one embodiment;

FIG. 720 illustrates a surgical instrument system comprising severalhandle assemblies and a shaft assembly selectively attachable to thehandle assemblies in accordance with at least one embodiment;

FIG. 721 is an elevational view of a handle assembly of FIG. 720 inaccordance with at least one embodiment;

FIG. 722 is an elevational view of a handle assembly of FIG. 720 inaccordance with at least one embodiment;

FIG. 723 is an elevational view of a handle assembly of FIG. 720 inaccordance with at least one embodiment;

FIG. 724 is an elevational view of a handle assembly and the shaftassembly of FIG. 720 in accordance with at least one embodiment;

FIG. 725 is an elevational view of the handle assembly of FIG. 722attached to the shaft assembly of FIG. 720 in accordance with at leastone embodiment;

FIG. 726 is an elevational view of the handle assembly of FIG. 722 andthe shaft assembly of FIG. 720 in accordance with at least oneembodiment;

FIG. 727 is an elevational view of the handle assembly of FIG. 723 andthe shaft assembly of FIG. 720 in accordance with at least oneembodiment;

FIG. 728 is a perspective view of the shaft assembly of FIG. 720 ;

FIG. 729 is a proximal end view of the handle assembly of FIG. 721 ;

FIG. 730 is a proximal end view of the handle assembly of FIG. 722 ;

FIG. 731 is a proximal end view of the handle assembly of FIG. 723 ;

FIG. 732 is a proximal end view of the shaft assembly of FIG. 724 ;

FIG. 733 illustrates a chart depicting various functions of the surgicalinstrument system of FIG. 720 ;

FIG. 734 is an exploded view of one of the handle assemblies and theshaft assembly of FIG. 720 ;

FIG. 735 depicts various aspects of the handle assembly of FIG. 734 ;

FIG. 736 is an exploded view of the handle assembly of FIG. 722 and theshaft assembly of FIG. 720 ;

FIG. 737 depicts various aspects of the handle assembly of FIG. 736 ;

FIG. 738 is a proximal end view of the handle assembly of FIG. 736 ;

FIG. 739 illustrates a chart depicting various functions of the handleassembly of FIG. 736 ;

FIG. 740 is a partial exploded view the handle assembly of FIG. 721 andthe shaft assembly of FIG. 720 ;

FIG. 741 depicts various aspects of the handle assembly of FIG. 740 ;

FIG. 742 is a proximal end view of the handle assembly of FIG. 740 ;

FIG. 743 illustrates a chart depicting various functions of the handleassembly of FIG. 740 ;

FIG. 744 illustrates a shaft assembly in accordance with at least oneembodiment;

FIG. 745 is a block diagram illustrating the electrical connections of asurgical instrument system in accordance with at least one embodiment;

FIG. 746 illustrates a surgical system comprising a handle and a shaftassembly in accordance with at least one embodiment;

FIG. 747 is a perspective view of the handle assembly of FIG. 746 ;

FIG. 748 is a cut-away view of a curved cylinder of the handle assemblyof FIG. 746 ;

FIG. 749 is a partial cross-sectional view of the curved cylinder ofFIG. 747 illustrating an electroactive polymer located in the cylinderin a non-energized state;

FIG. 750 is a partial cross-sectional view of the curved cylinder ofFIG. 747 illustrating the electroactive polymer located in the cylinderin an energized state;

FIG. 751 is a block diagram illustrating various aspects of the handleand shaft assembly of FIG. 746 in accordance with at least oneembodiment;

FIG. 752 is a graph illustrating the relationship between the forcesexperienced by an end effector and shaft of the surgical system of FIG.746 and the voltage applied to the electroactive polymer over time;

FIG. 753 is a graph illustrating the compressive force applied by theelectroactive polymer over time;

FIG. 754 illustrates a surgical system comprising a handle and a shaftassembly in accordance with at least one embodiment;

FIG. 755 is a partial perspective view of the shaft assembly of FIG. 754comprising a locking mechanism;

FIG. 756 is a perspective view of the locking mechanism of FIG. 755 inan unlocked configuration;

FIG. 757 is a perspective view of the locking mechanism of FIG. 755 in alocked configuration;

FIGS. 758-760 illustrate the locking mechanism of FIG. 755 in threedifferent states during the operation of the surgical instrument system;

FIG. 761 is a partial perspective view of a distal attachment portionselectively attachable to the surgical system of FIG. 754 ;

FIG. 762 is a graph illustrating possible drive force curves of thedistal attachment portion of FIG. 761 ;

FIG. 763 is a flow chart illustrating a start-up process of a surgicalinstrument system in accordance with at least one embodiment;

FIG. 764 is a partial perspective view of a distal end of a shaftassembly of a surgical instrument in accordance with at least oneembodiment;

FIG. 765 is a partial perspective view of the distal end of FIG. 764illustrating an extended lock element;

FIG. 766 is a partial perspective view of an interconnection between ashaft and a handle of a surgical instrument in accordance with at leastone embodiment;

FIG. 767 is a partial perspective view of a drive system of a surgicalinstrument comprising an electric motor input and a shiftabletransmission;

FIG. 768 is a partial perspective view of a drive system of a surgicalinstrument comprising an electric motor input and a shiftabletransmission;

FIG. 769 depicts the transmission of FIG. 768 in a first configuration;

FIG. 770 depicts the transmission of FIG. 768 being shifted into asecond configuration;

FIG. 771 depicts the transmission of FIG. 768 in the secondconfiguration;

FIG. 772 is a partial cross-sectional view of a drive system of asurgical instrument comprising a shiftable input in accordance with atleast one embodiment;

FIG. 773 depicts the surgical instrument of FIG. 772 in an openconfiguration;

FIG. 774 depicts the surgical instrument of FIG. 772 in an unarticulatedconfiguration;

FIG. 775 depicts the surgical instrument of FIG. 772 in an articulatedconfiguration;

FIG. 776 is a partial cross-sectional view of a drive system of asurgical instrument comprising a transmission in accordance with atleast one embodiment;

FIG. 777 depicts the transmission in a second configuration;

FIG. 778 is a partial cross-sectional view of a drive system of asurgical instrument in accordance with at least one embodiment;

FIG. 779 is a partial perspective view of a drive system of a surgicalinstrument in accordance with at least one embodiment;

FIG. 780 is a detail view of the drive system of FIG. 779 ;

FIG. 781 is a perspective view of flexible drive shafts in accordancewith at least one embodiment;

FIG. 782 is a partial perspective view of the surgical instrument ofFIG. 779 ;

FIG. 783 is a partial perspective view of a surgical instrument systemin accordance with at least one embodiment;

FIG. 784 is a side view of a drive system of the surgical instrumentsystem of FIG. 783 ;

FIG. 785 is an end view of the drive system of FIG. 784 ;

FIG. 786 is a partial perspective view of a drive system of a surgicalinstrument in accordance with at least one embodiment attached to afirst handle;

FIG. 787 is a partial perspective view of the drive system of FIG. 786attached to a second handle;

FIG. 788 is a partial cross-sectional view of a drive system of asurgical instrument in accordance with at least one embodiment;

FIG. 789 is an end view of a portion of the surgical instrument of FIG.788 ;

FIG. 790 is a cross-sectional end view of a portion of a surgicalinstrument in accordance with at least one embodiment;

FIG. 791 is a perspective view of the drive system of FIG. 788 ;

FIG. 792 is a partial perspective view of a drive system in accordancewith at least one embodiment illustrated with some components removed;

FIG. 793 is a partial perspective view of the surgical instrument ofFIG. 790 ;

FIG. 794 is a graph depicting the rotation and articulation of an endeffector of a surgical instrument;

FIG. 795 is a partial top view of a shaft assembly comprising arotatable and articulatable end effector;

FIG. 796 is a graph depicting the rotation and articulation of the endeffector of FIG. 795 in at least one instance;

FIG. 797 is another partial top view of the shaft assembly of FIG. 795 ;

FIG. 798 is a graph depicted the rotation and articulation of the endeffector of FIG. 795 in at least one instance;

FIG. 799 is a partial cross-sectional view of a surgical instrument inaccordance with at least one embodiment;

FIG. 800 is a partial cross-sectional view of the surgical instrument ofFIG. 799 ;

FIG. 801 is a partial cross-sectional view of a surgical instrumentcomprising a shiftable transmission in accordance with at least oneembodiment;

FIG. 802 illustrates the transmission of FIG. 801 in a firstconfiguration;

FIG. 803 illustrates the transmission of FIG. 802 in a secondconfiguration;

FIG. 804 is a partial perspective view of a surgical instrument inaccordance with at least one embodiment;

FIG. 805 is a partial cross-sectional view of a surgical instrumentcomprising a shaft assembly and a detachable end effector in accordancewith at least one embodiment;

FIG. 806 depicts the end effector in an attached state;

FIG. 807 is a partial cross-sectional view of a drive shaftinterconnection in accordance with at least one embodiment;

FIG. 808 is a partial cross-sectional view of a shaft assemblycomprising an end effector and an articulation system in accordance withat least one embodiment;

FIG. 809 is a partial cross-sectional view of the shaft assembly of FIG.808 ;

FIG. 810 is a partial exploded view of the articulation system of FIG.808 ;

FIG. 811 is a partial cross-sectional view of a surgical instrumentcomprising an articulation system in accordance with at least oneembodiment;

FIG. 812 is a partial cross-sectional view of the surgical instrument ofFIG. 811 in an articulated configuration;

FIG. 813 is a partial plan view of an articulation system of a surgicalinstrument in accordance with at least one embodiment;

FIG. 814 is a partial plan view of an articulation system of a surgicalinstrument in accordance with at least one embodiment;

FIG. 815 is a partial plan view of an articulation system of a surgicalinstrument in accordance with at least one embodiment;

FIG. 816 is a partial cross-sectional view of a surgical instrumentincluding a jaw assembly capable of grasping and dissection inaccordance with at least one embodiment;

FIG. 817 is a graph depicting the force, speed, and orientation of thejaw assembly of FIG. 816 in accordance with at least one embodiment;

FIG. 818 is a partial perspective view of bipolar forceps being used tocut tissue;

FIG. 819 is a perspective view of the bipolar forceps of FIG. 818 ;

FIG. 820 is a graph depicting the force and speed of the jaws of thebipolar forceps of FIG. 818 in accordance with at least one embodiment;

FIG. 821 is another graph depicting the operation of the bipolar forcepsof FIG. 818 in accordance with at least one embodiment;

FIG. 822 is a partial top plan view of an embodiment of a surgicalinstrument;

FIG. 823 is a partial side elevation view of an embodiment of a surgicalinstrument;

FIG. 824 is a partial top plan view of various possible configurationsof an embodiment of a surgical instrument;

FIG. 825 is a partial side elevation view of various possibleconfigurations of an embodiment of a surgical instrument;

FIG. 826 is a partial top plan view of an embodiment of a surgicalinstrument;

FIG. 827 is a partial side elevation view of an embodiment of thesurgical instrument depicted in FIG. 826 ;

FIG. 828 is a partial top plan view of an embodiment of a surgicalinstrument;

FIG. 829 is a partial top plan view of an embodiment of a surgicalinstrument;

FIG. 830 is a partial top plan view of an embodiment of a surgicalinstrument;

FIG. 831 is a partial top plan view of an embodiment of a surgicalinstrument;

FIG. 832 is a partial top plan view of an embodiment of a surgicalinstrument which depicts a manufacturing envelope from which an endeffector of the surgical instrument is created;

FIG. 833 is a partial side elevation view of an embodiment of thesurgical instrument depicted in FIG. 832 ;

FIG. 834 is a partial top plan view of an embodiment of a surgicalinstrument which depicts a manufacturing envelope from which an endeffector of the surgical instrument is created;

FIG. 835 is a partial side elevation view of an embodiment of thesurgical instrument depicted in FIG. 834 which depicts a manufacturingenvelope from which an end effector of the surgical instrument iscreated;

FIG. 836 is a top perspective view of a jaw of a surgical instrument;

FIG. 837 is a partial perspective view of the jaw depicted in FIG. 836 ;

FIG. 838 is a top plan view of the jaw depicted in FIG. 836 ;

FIG. 839 is a bottom perspective view of the jaw depicted in FIG. 836 ;

FIG. 840 is a top perspective view of a jaw of a surgical instrument;

FIG. 841 is a top plan view of the jaw depicted in FIG. 840 ;

FIG. 842 is a partial perspective view of the jaw depicted in FIG. 840 ;

FIG. 843 is a partial perspective view of a jaw of a surgicalinstrument;

FIG. 844 is a partial cross-sectional view of a surgical instrumentincluding a jaw assembly capable of grasping and dissection inaccordance with at least one embodiment;

FIG. 845 is a graph depicting the force, speed, and orientation of thejaw assembly of FIG. 844 in accordance with at least one embodiment;

FIG. 846 is a partial perspective view of bipolar forceps being used tocut tissue;

FIG. 847 is a perspective view of the bipolar forceps of FIG. 846 ;

FIG. 848 is a graph depicting the force and speed of the jaws of thebipolar forceps of FIG. 846 in accordance with at least one embodiment;and

FIG. 849 is another graph depicting the operation of the bipolar forcepsof FIG. 846 in accordance with at least one embodiment.

Corresponding reference characters indicate corresponding partsthroughout the several views. The exemplifications set out hereinillustrate various embodiments of the invention, in one form, and suchexemplifications are not to be construed as limiting the scope of theinvention in any manner.

DETAILED DESCRIPTION

Applicant of the present application owns the following U.S. PatentApplications that were filed on Dec. 14, 2018 which are each hereinincorporated by reference in their respective entireties:

-   -   U.S. patent application Ser. No. 16/220,281, entitled SURGICAL        INSTRUMENT WITH A HARDWARE-ONLY CONTROL CIRCUIT;    -   U.S. patent application Ser. No. 16/220,301, entitled SURGICAL        INSTRUMENT WITH ACOUSTIC-BASED MOTOR CONTROL;    -   U.S. patent application Ser. No. 16/220,313, entitled SURGICAL        INSTRUMENT COMPRISING A PLURALITY OF DRIVE SYSTEMS;    -   U.S. patent application Ser. No. 16/220,296, entitled SURGICAL        INSTRUMENT COMPRISING A CONTROL CIRCUIT;    -   U.S. patent application Ser. No. 16/220,309, entitled SURGICAL        INSTRUMENTS COMPRISING BUTTON CIRCUITS;    -   U.S. patent application Ser. No. 16/220,318, entitled SURGICAL        INSTRUMENT COMPRISING A CONTROL SYSTEM THAT USES INPUT FROM A        STRAIN GAGE CIRCUIT;    -   U.S. patent application Ser. No. 16/220,273, entitled SURGICAL        INSTRUMENT WITH A SENSING ARRAY; and    -   U.S. patent application Ser. No. 16/220,280, entitled SURGICAL        INSTRUMENT WITH ENVIRONMENT SENSING.

Applicant of the present application owns the following U.S. ProvisionalPatent Applications, filed on Dec. 12, 2018, each of which is hereinincorporated by reference in its entirety:

-   -   U.S. Provisional Patent Application Ser. No. 62/778,571,        entitled SURGICAL INSTRUMENT SYSTEMS;    -   U.S. Provisional Patent Application Ser. No. 62/778,572,        entitled SURGICAL INSTRUMENT SYSTEMS; and    -   U.S. Provisional Patent Application Ser. No. 62/778,573,        entitled SURGICAL INSTRUMENT SYSTEMS.

Applicant of the present application owns the following U.S. PatentApplications that were filed on Oct. 26, 2018 which are each hereinincorporated by reference in their respective entireties:

-   -   U.S. patent application Ser. No. 16/172,130, entitled CLIP        APPLIER COMPRISING INTERCHANGEABLE CLIP RELOADS;    -   U.S. patent application Ser. No. 16/172,066, entitled CLIP        APPLIER COMPRISING A MOVABLE CLIP MAGAZINE;    -   U.S. patent application Ser. No. 16/172,078, entitled CLIP        APPLIER COMPRISING A ROTATABLE CLIP MAGAZINE;    -   U.S. patent application Ser. No. 16/172,087, entitled CLIP        APPLIER COMPRISING CLIP ADVANCING SYSTEMS;    -   U.S. patent application Ser. No. 16/172,094, entitled CLIP        APPLIER COMPRISING A CLIP CRIMPING SYSTEM;    -   U.S. patent application Ser. No. 16/172,128, entitled CLIP        APPLIER COMPRISING A RECIPROCATING CLIP ADVANCING MEMBER;    -   U.S. patent application Ser. No. 16/172,168, entitled CLIP        APPLIER COMPRISING A MOTOR CONTROLLER;    -   U.S. patent application Ser. No. 16/172,164, entitled SURGICAL        SYSTEM COMPRISING A SURGICAL TOOL AND A SURGICAL HUB; and    -   U.S. patent application Ser. No. 16/172,303, entitled METHOD FOR        OPERATING A POWERED ARTICULATING MULTI-CLIP APPLIER.

Applicant of the present application owns the following U.S. PatentApplications that were filed on Oct. 26, 2018 which are each hereinincorporated by reference in their respective entireties:

-   -   U.S. patent application Ser. No. 16/172,328, entitled METHOD OF        HUB COMMUNICATION WITH SURGICAL INSTRUMENT SYSTEMS;    -   U.S. patent application Ser. No. 16/172,280, entitled METHOD FOR        PRODUCING A SURGICAL INSTRUMENT COMPRISING A SMART ELECTRICAL        SYSTEM;    -   U.S. patent application Ser. No. 16/172,219, entitled METHOD OF        HUB COMMUNICATION WITH SURGICAL INSTRUMENT SYSTEMS;    -   U.S. patent application Ser. No. 16/172,248, entitled METHOD FOR        COMMUNICATING WITH SURGICAL INSTRUMENT SYSTEMS;    -   U.S. patent application Ser. No. 16/172,198, entitled METHOD OF        HUB COMMUNICATION WITH SURGICAL INSTRUMENT SYSTEMS; and    -   U.S. patent application Ser. No. 16/172,155, entitled METHOD OF        HUB COMMUNICATION WITH SURGICAL INSTRUMENT SYSTEMS.

Applicant of the present application owns the following U.S. PatentApplications that were filed on Aug. 24, 2018 which are each hereinincorporated by reference in their respective entireties:

-   -   U.S. patent application Ser. No. 16/112,129, entitled SURGICAL        SUTURING INSTRUMENT CONFIGURED TO MANIPULATE TISSUE USING        MECHANICAL AND ELECTRICAL POWER;    -   U.S. patent application Ser. No. 16/112,155, entitled SURGICAL        SUTURING INSTRUMENT COMPRISING A CAPTURE WIDTH WHICH IS LARGER        THAN TROCAR DIAMETER;    -   U.S. patent application Ser. No. 16/112,168, entitled SURGICAL        SUTURING INSTRUMENT COMPRISING A NON-CIRCULAR NEEDLE;    -   U.S. patent application Ser. No. 16/112,180, entitled ELECTRICAL        POWER OUTPUT CONTROL BASED ON MECHANICAL FORCES;    -   U.S. patent application Ser. No. 16/112,193, entitled REACTIVE        ALGORITHM FOR SURGICAL SYSTEM;    -   U.S. patent application Ser. No. 16/112,099, entitled SURGICAL        INSTRUMENT COMPRISING AN ADAPTIVE ELECTRICAL SYSTEM;    -   U.S. patent application Ser. No. 16/112,112, entitled CONTROL        SYSTEM ARRANGEMENTS FOR A MODULAR SURGICAL INSTRUMENT;    -   U.S. patent application Ser. No. 16/112,119, entitled ADAPTIVE        CONTROL PROGRAMS FOR A SURGICAL SYSTEM COMPRISING MORE THAN ONE        TYPE OF CARTRIDGE;    -   U.S. patent application Ser. No. 16/112,097, entitled SURGICAL        INSTRUMENT SYSTEMS COMPRISING BATTERY ARRANGEMENTS;    -   U.S. patent application Ser. No. 16/112,109, entitled SURGICAL        INSTRUMENT SYSTEMS COMPRISING HANDLE ARRANGEMENTS;    -   U.S. patent application Ser. No. 16/112,114, entitled SURGICAL        INSTRUMENT SYSTEMS COMPRISING FEEDBACK MECHANISMS;    -   U.S. patent application Ser. No. 16/112,117, entitled SURGICAL        INSTRUMENT SYSTEMS COMPRISING LOCKOUT MECHANISMS;    -   U.S. patent application Ser. No. 16/112,095, entitled SURGICAL        INSTRUMENTS COMPRISING A LOCKABLE END EFFECTOR SOCKET;    -   U.S. patent application Ser. No. 16/112,121, entitled SURGICAL        INSTRUMENTS COMPRISING A SHIFTING MECHANISM;    -   U.S. patent application Ser. No. 16/112,151, entitled SURGICAL        INSTRUMENTS COMPRISING A SYSTEM FOR ARTICULATION AND ROTATION        COMPENSATION;    -   U.S. patent application Ser. No. 16/112,154, entitled SURGICAL        INSTRUMENTS COMPRISING A BIASED SHIFTING MECHANISM;    -   U.S. patent application Ser. No. 16/112,226, entitled SURGICAL        INSTRUMENTS COMPRISING AN ARTICULATION DRIVE THAT PROVIDES FOR        HIGH ARTICULATION ANGLES;    -   U.S. patent application Ser. No. 16/112,062, entitled SURGICAL        DISSECTORS AND MANUFACTURING TECHNIQUES;    -   U.S. patent application Ser. No. 16/112,098, entitled SURGICAL        DISSECTORS CONFIGURED TO APPLY MECHANICAL AND ELECTRICAL ENERGY;    -   U.S. patent application Ser. No. 16/112,237, entitled SURGICAL        CLIP APPLIER CONFIGURED TO STORE CLIPS IN A STORED STATE;    -   U.S. patent application Ser. No. 16/112,245, entitled SURGICAL        CLIP APPLIER COMPRISING AN EMPTY CLIP CARTRIDGE LOCKOUT;    -   U.S. patent application Ser. No. 16/112,249, entitled SURGICAL        CLIP APPLIER COMPRISING AN AUTOMATIC CLIP FEEDING SYSTEM;    -   U.S. patent application Ser. No. 16/112,253, entitled SURGICAL        CLIP APPLIER COMPRISING ADAPTIVE FIRING CONTROL; and    -   U.S. patent application Ser. No. 16/112,257, entitled SURGICAL        CLIP APPLIER COMPRISING ADAPTIVE CONTROL IN RESPONSE TO A STRAIN        GAUGE CIRCUIT.

Applicant of the present application owns the following U.S. PatentApplications that were filed on May 1, 2018 and which are each hereinincorporated by reference in their respective entireties:

-   -   U.S. Provisional Patent Application Ser. No. 62/665,129,        entitled SURGICAL SUTURING SYSTEMS;    -   U.S. Provisional Patent Application Ser. No. 62/665,139,        entitled SURGICAL INSTRUMENTS COMPRISING CONTROL SYSTEMS;    -   U.S. Provisional Patent Application Ser. No. 62/665,177,        entitled SURGICAL INSTRUMENTS COMPRISING HANDLE ARRANGEMENTS;    -   U.S. Provisional Patent Application Ser. No. 62/665,128,        entitled MODULAR SURGICAL INSTRUMENTS;    -   U.S. Provisional Patent Application Ser. No. 62/665,192,        entitled SURGICAL DISSECTORS; and    -   U.S. Provisional Patent Application Ser. No. 62/665,134,        entitled SURGICAL CLIP APPLIER.

Applicant of the present application owns the following U.S. PatentApplications that were filed on Feb. 28, 2018 and which are each hereinincorporated by reference in their respective entireties:

-   -   U.S. patent application Ser. No. 15/908,021, entitled SURGICAL        INSTRUMENT WITH REMOTE RELEASE;    -   U.S. patent application Ser. No. 15/908,012, entitled SURGICAL        INSTRUMENT HAVING DUAL ROTATABLE MEMBERS TO EFFECT DIFFERENT        TYPES OF END EFFECTOR MOVEMENT;    -   U.S. patent application Ser. No. 15/908,040, entitled SURGICAL        INSTRUMENT WITH ROTARY DRIVE SELECTIVELY ACTUATING MULTIPLE END        EFFECTOR FUNCTIONS;    -   U.S. patent application Ser. No. 15/908,057, entitled SURGICAL        INSTRUMENT WITH ROTARY DRIVE SELECTIVELY ACTUATING MULTIPLE END        EFFECTOR FUNCTIONS;    -   U.S. patent application Ser. No. 15/908,058, entitled SURGICAL        INSTRUMENT WITH MODULAR POWER SOURCES; and    -   U.S. patent application Ser. No. 15/908,143, entitled SURGICAL        INSTRUMENT WITH SENSOR AND/OR CONTROL SYSTEMS.

Applicant of the present application owns the following U.S. PatentApplications that were filed on Oct. 30, 2017 and which are each hereinincorporated by reference in their respective entireties:

-   -   U.S. Provisional Patent Application Ser. No. 62/578,793,        entitled SURGICAL INSTRUMENT WITH REMOTE RELEASE;    -   U.S. Provisional Patent Application Ser. No. 62/578,804,        entitled SURGICAL INSTRUMENT HAVING DUAL ROTATABLE MEMBERS TO        EFFECT DIFFERENT TYPES OF END EFFECTOR MOVEMENT;    -   U.S. Provisional Patent Application Ser. No. 62/578,817,        entitled SURGICAL INSTRUMENT WITH ROTARY DRIVE SELECTIVELY        ACTUATING MULTIPLE END EFFECTOR FUNCTIONS;    -   U.S. Provisional Patent Application Ser. No. 62/578,835,        entitled SURGICAL INSTRUMENT WITH ROTARY DRIVE SELECTIVELY        ACTUATING MULTIPLE END EFFECTOR FUNCTIONS;    -   U.S. Provisional Patent Application Ser. No. 62/578,844,        entitled SURGICAL INSTRUMENT WITH MODULAR POWER SOURCES; and    -   U.S. Provisional Patent Application Ser. No. 62/578,855,        entitled SURGICAL INSTRUMENT WITH SENSOR AND/OR CONTROL SYSTEMS.

Applicant of the present application owns the following U.S. ProvisionalPatent Applications, filed on Dec. 28, 2017, the disclosure of each ofwhich is herein incorporated by reference in its entirety:

-   -   U.S. Provisional Patent Application Ser. No. 62/611,341,        entitled INTERACTIVE SURGICAL PLATFORM;    -   U.S. Provisional Patent Application Ser. No. 62/611,340,        entitled CLOUD-BASED MEDICAL ANALYTICS; and    -   U.S. Provisional Patent Application Ser. No. 62/611,339,        entitled ROBOT ASSISTED SURGICAL PLATFORM.

Applicant of the present application owns the following U.S. ProvisionalPatent Applications, filed on Mar. 28, 2018, each of which is hereinincorporated by reference in its entirety:

-   -   U.S. Provisional Patent Application Ser. No. 62/649,302,        entitled INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED        COMMUNICATION CAPABILITIES;    -   U.S. Provisional Patent Application Ser. No. 62/649,294,        entitled DATA STRIPPING METHOD TO INTERROGATE PATIENT RECORDS        AND CREATE ANONYMIZED RECORD;    -   U.S. Provisional Patent Application Ser. No. 62/649,300,        entitled SURGICAL HUB SITUATIONAL AWARENESS;    -   U.S. Provisional Patent Application Ser. No. 62/649,309,        entitled SURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN        OPERATING THEATER;    -   U.S. Provisional Patent Application Ser. No. 62/649,310,        entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS;    -   U.S. Provisional Patent Application Ser. No. 62/649,291,        entitled USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TO        DETERMINE PROPERTIES OF BACK SCATTERED LIGHT;    -   U.S. Provisional Patent Application Ser. No. 62/649,296,        entitled ADAPTIVE CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES;    -   U.S. Provisional Patent Application Ser. No. 62/649,333,        entitled CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND        RECOMMENDATIONS TO A USER;    -   U.S. Provisional Patent Application Ser. No. 62/649,327,        entitled CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND        AUTHENTICATION TRENDS AND REACTIVE MEASURES;    -   U.S. Provisional Patent Application Ser. No. 62/649,315,        entitled DATA HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS        NETWORK;    -   U.S. Provisional Patent Application Ser. No. 62/649,313,        entitled CLOUD INTERFACE FOR COUPLED SURGICAL DEVICES;    -   U.S. Provisional Patent Application Ser. No. 62/649,320,        entitled DRIVE ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL        PLATFORMS;    -   U.S. Provisional Patent Application Ser. No. 62/649,307,        entitled AUTOMATIC TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL        PLATFORMS; and    -   U.S. Provisional Patent Application Ser. No. 62/649,323,        entitled SENSING ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL        PLATFORMS.

Applicant of the present application owns the following U.S. PatentApplications, filed on Mar. 29, 2018, each of which is hereinincorporated by reference in its entirety:

-   -   U.S. patent application Ser. No. 15/940,641, entitled        INTERACTIVE SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION        CAPABILITIES;    -   U.S. patent application Ser. No. 15/940,648, entitled        INTERACTIVE SURGICAL SYSTEMS WITH CONDITION HANDLING OF DEVICES        AND DATA CAPABILITIES;    -   U.S. patent application Ser. No. 15/940,656, entitled SURGICAL        HUB COORDINATION OF CONTROL AND COMMUNICATION OF OPERATING ROOM        DEVICES;    -   U.S. patent application Ser. No. 15/940,666, entitled SPATIAL        AWARENESS OF SURGICAL HUBS IN OPERATING ROOMS;    -   U.S. patent application Ser. No. 15/940,670, entitled        COOPERATIVE UTILIZATION OF DATA DERIVED FROM SECONDARY SOURCES        BY INTELLIGENT SURGICAL HUBS;    -   U.S. patent application Ser. No. 15/940,677, entitled SURGICAL        HUB CONTROL ARRANGEMENTS;    -   U.S. patent application Ser. No. 15/940,632, entitled DATA        STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE        ANONYMIZED RECORD;    -   U.S. patent application Ser. No. 15/940,640, entitled        COMMUNICATION HUB AND STORAGE DEVICE FOR STORING PARAMETERS AND        STATUS OF A SURGICAL DEVICE TO BE SHARED WITH CLOUD BASED        ANALYTICS SYSTEMS;    -   U.S. patent application Ser. No. 15/940,645, entitled SELF        DESCRIBING DATA PACKETS GENERATED AT AN ISSUING INSTRUMENT;    -   U.S. patent application Ser. No. 15/940,649, entitled DATA        PAIRING TO INTERCONNECT A DEVICE MEASURED PARAMETER WITH AN        OUTCOME;    -   U.S. patent application Ser. No. 15/940,654, entitled SURGICAL        HUB SITUATIONAL AWARENESS;    -   U.S. patent application Ser. No. 15/940,663, entitled SURGICAL        SYSTEM DISTRIBUTED PROCESSING;    -   U.S. patent application Ser. No. 15/940,668, entitled        AGGREGATION AND REPORTING OF SURGICAL HUB DATA;    -   U.S. patent application Ser. No. 15/940,671, entitled SURGICAL        HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER;    -   U.S. patent application Ser. No. 15/940,686, entitled DISPLAY OF        ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINEAR STAPLE LINE;    -   U.S. patent application Ser. No. 15/940,700, entitled STERILE        FIELD INTERACTIVE CONTROL DISPLAYS;    -   U.S. patent application Ser. No. 15/940,629, entitled COMPUTER        IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS;    -   U.S. patent application Ser. No. 15/940,704, entitled USE OF        LASER LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE        PROPERTIES OF BACK SCATTERED LIGHT;    -   U.S. patent application Ser. No. 15/940,722, entitled        CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF        MONO-CHROMATIC LIGHT REFRACTIVITY; and    -   U.S. patent application Ser. No. 15/940,742, entitled DUAL CMOS        ARRAY IMAGING.

Applicant of the present application owns the following U.S. PatentApplications, filed on Mar. 29, 2018, each of which is hereinincorporated by reference in its entirety:

-   -   U.S. patent application Ser. No. 15/940,636, entitled ADAPTIVE        CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES;    -   U.S. patent application Ser. No. 15/940,653, entitled ADAPTIVE        CONTROL PROGRAM UPDATES FOR SURGICAL HUBS;    -   U.S. patent application Ser. No. 15/940,660, entitled        CLOUD-BASED MEDICAL ANALYTICS FOR CUSTOMIZATION AND        RECOMMENDATIONS TO A USER;    -   U.S. patent application Ser. No. 15/940,679, entitled        CLOUD-BASED MEDICAL ANALYTICS FOR LINKING OF LOCAL USAGE TRENDS        WITH THE RESOURCE ACQUISITION BEHAVIORS OF LARGER DATA SET;    -   U.S. patent application Ser. No. 15/940,694, entitled        CLOUD-BASED MEDICAL ANALYTICS FOR MEDICAL FACILITY SEGMENTED        INDIVIDUALIZATION OF INSTRUMENT FUNCTION;    -   U.S. patent application Ser. No. 15/940,634, entitled        CLOUD-BASED MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION        TRENDS AND REACTIVE MEASURES;    -   U.S. patent application Ser. No. 15/940,706, entitled DATA        HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK; and    -   U.S. patent application Ser. No. 15/940,675, entitled CLOUD        INTERFACE FOR COUPLED SURGICAL DEVICES.

Applicant of the present application owns the following U.S. PatentApplications, filed on Mar. 29, 2018, each of which is hereinincorporated by reference in its entirety:

-   -   U.S. patent application Ser. No. 15/940,627, entitled DRIVE        ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;    -   U.S. patent application Ser. No. 15/940,637, entitled        COMMUNICATION ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL        PLATFORMS;    -   U.S. patent application Ser. No. 15/940,642, entitled CONTROLS        FOR ROBOT-ASSISTED SURGICAL PLATFORMS;    -   U.S. patent application Ser. No. 15/940,676, entitled AUTOMATIC        TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;    -   U.S. patent application Ser. No. 15/940,680, entitled        CONTROLLERS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;    -   U.S. patent application Ser. No. 15/940,683, entitled        COOPERATIVE SURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICAL        PLATFORMS;    -   U.S. patent application Ser. No. 15/940,690, entitled DISPLAY        ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and    -   U.S. patent application Ser. No. 15/940,711, entitled SENSING        ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.

Applicant of the present application owns the following U.S. ProvisionalPatent Applications, filed on Mar. 30, 2018, each of which is hereinincorporated by reference in its entirety:

-   -   U.S. Provisional Patent Application Ser. No. 62/650,887,        entitled SURGICAL SYSTEMS WITH OPTIMIZED SENSING CAPABILITIES;    -   U.S. Provisional Patent Application Ser. No. 62/650,877,        entitled SURGICAL SMOKE EVACUATION SENSING AND CONTROLS;    -   U.S. Provisional Patent Application Ser. No. 62/650,882,        entitled SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL        PLATFORM; and    -   U.S. Provisional Patent Application Ser. No. 62/650,898,        entitled CAPACITIVE COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY        ELEMENTS.

Applicant of the present application owns the following U.S. ProvisionalPatent Application, filed on Apr. 19, 2018, which is herein incorporatedby reference in its entirety:

-   -   U.S. Provisional Patent Application Ser. No. 62/659,900,        entitled METHOD OF HUB COMMUNICATION.

Applicant of the present application owns the following U.S. ProvisionalPatent Applications, filed on Oct. 25, 2018, each of which is hereinincorporated by reference in its entirety:

-   -   U.S. Provisional Patent Application Ser. No. 62/750,529,        entitled METHOD FOR OPERATING A POWERED ARTICULATING MULTI-CLIP        APPLIER;    -   U.S. Provisional Patent Application Ser. No. 62/750,539,        entitled SURGICAL CLIP APPLIER; and    -   U.S. Provisional Patent Application Ser. No. 62/750,555,        entitled SURGICAL CLIP APPLIER.

Numerous specific details are set forth to provide a thoroughunderstanding of the overall structure, function, manufacture, and useof the embodiments as described in the specification and illustrated inthe accompanying drawings. Well-known operations, components, andelements have not been described in detail so as not to obscure theembodiments described in the specification. The reader will understandthat the embodiments described and illustrated herein are non-limitingexamples, and thus it can be appreciated that the specific structuraland functional details disclosed herein may be representative andillustrative. Variations and changes thereto may be made withoutdeparting from the scope of the claims.

The terms “comprise” (and any form of comprise, such as “comprises” and“comprising”), “have” (and any form of have, such as “has” and“having”), “include” (and any form of include, such as “includes” and“including”), and “contain” (and any form of contain, such as “contains”and “containing”) are open-ended linking verbs. As a result, a surgicalsystem, device, or apparatus that “comprises,” “has,” “includes”, or“contains” one or more elements possesses those one or more elements,but is not limited to possessing only those one or more elements.Likewise, an element of a system, device, or apparatus that “comprises,”“has,” “includes”, or “contains” one or more features possesses thoseone or more features, but is not limited to possessing only those one ormore features.

The terms “proximal” and “distal” are used herein with reference to aclinician manipulating the handle portion of the surgical instrument.The term “proximal” refers to the portion closest to the clinician andthe term “distal” refers to the portion located away from the clinician.It will be further appreciated that, for convenience and clarity,spatial terms such as “vertical”, “horizontal”, “up”, and “down” may beused herein with respect to the drawings. However, surgical instrumentsare used in many orientations and positions, and these terms are notintended to be limiting and/or absolute.

Various exemplary devices and methods are provided for performinglaparoscopic and minimally invasive surgical procedures. However, thereader will readily appreciate that the various methods and devicesdisclosed herein can be used in numerous surgical procedures andapplications including, for example, in connection with open surgicalprocedures. As the present Detailed Description proceeds, the readerwill further appreciate that the various instruments disclosed hereincan be inserted into a body in any way, such as through a naturalorifice, through an incision or puncture hole formed in tissue, etc. Theworking portions or end effector portions of the instruments can beinserted directly into a patient's body or can be inserted through anaccess device that has a working channel through which the end effectorand elongate shaft of a surgical instrument can be advanced.

Before explaining various aspects of surgical devices and generators indetail, it should be noted that the illustrative examples are notlimited in application or use to the details of construction andarrangement of parts illustrated in the accompanying drawings anddescription. The illustrative examples may be implemented orincorporated in other aspects, variations and modifications, and may bepracticed or carried out in various ways. Further, unless otherwiseindicated, the terms and expressions employed herein have been chosenfor the purpose of describing the illustrative examples for theconvenience of the reader and are not for the purpose of limitationthereof. Also, it will be appreciated that one or more of thefollowing-described aspects, expressions of aspects, and/or examples,can be combined with any one or more of the other following-describedaspects, expressions of aspects and/or examples.

Aspects of the present disclosure are presented for a comprehensivedigital medical system capable of spanning multiple medical facilitiesand configured to provide integrated and comprehensive improved medicalcare to a vast number of patients. The comprehensive digital medicalsystem includes a cloud-based medical analytics system that isconfigured to interconnect to multiple surgical hubs located across manydifferent medical facilities. The surgical hubs are configured tointerconnect with one or more surgical devices that are used to conductmedical procedures on patients. The surgical hubs provide a wide arrayof functionality to improve the outcomes of medical procedures. The datagenerated by the various surgical devices and medical hubs about thepatient and the medical procedure may be transmitted to the cloud-basedmedical analytics system. This data may then be aggregated with similardata gathered from many other surgical hubs and surgical devices locatedat other medical facilities. Various patterns and correlations may befound through the cloud-based analytics system analyzing the collecteddata. Improvements in the techniques used to generate the data may begenerated as a result, and these improvements may then be disseminatedto the various surgical hubs and surgical devices. Due to theinterconnectedness of all of the aforementioned components, improvementsin medical procedures and practices may be found that otherwise may notbe found if the many components were not so interconnected. Variousexamples of structures and functions of these various components will bedescribed in more detail in the following description.

Referring to FIG. 1 , a computer-implemented interactive surgical system100 includes one or more surgical systems 102 and a cloud-based system(e.g., the cloud 104 that may include a remote server 113 coupled to astorage device 105). Each surgical system 102 includes at least onesurgical hub 106 in communication with the cloud 104 that may include aremote server 113. In one example, as illustrated in FIG. 1 , thesurgical system 102 includes a visualization system 108, a roboticsystem 110, and a handheld intelligent surgical instrument 112, whichare configured to communicate with one another and/or the hub 106. Insome aspects, a surgical system 102 may include an M number of hubs 106,an N number of visualization systems 108, an O number of robotic systems110, and a P number of handheld intelligent surgical instruments 112,where M, N, O, and P are integers greater than or equal to one.

FIG. 3 depicts an example of a surgical system 102 being used to performa surgical procedure on a patient who is lying down on an operatingtable 114 in a surgical operating room 116. A robotic system 110 is usedin the surgical procedure as a part of the surgical system 102. Therobotic system 110 includes a surgeon's console 118, a patient side cart120 (surgical robot), and a surgical robotic hub 122. The patient sidecart 120 can manipulate at least one removably coupled surgical tool 117through a minimally invasive incision in the body of the patient whilethe surgeon views the surgical site through the surgeon's console 118.An image of the surgical site can be obtained by a medical imagingdevice 124, which can be manipulated by the patient side cart 120 toorient the imaging device 124. The robotic hub 122 can be used toprocess the images of the surgical site for subsequent display to thesurgeon through the surgeon's console 118.

Other types of robotic systems can be readily adapted for use with thesurgical system 102. Various examples of robotic systems and surgicaltools that are suitable for use with the present disclosure aredescribed in U.S. Provisional Patent Application Ser. No. 62/611,339,entitled ROBOT ASSISTED SURGICAL PLATFORM, filed Dec. 28, 2017, thedisclosure of which is herein incorporated by reference in its entirety.

Various examples of cloud-based analytics that are performed by thecloud 104, and are suitable for use with the present disclosure, aredescribed in U.S. Provisional Patent Application Ser. No. 62/611,340,entitled CLOUD-BASED MEDICAL ANALYTICS, filed Dec. 28, 2017, thedisclosure of which is herein incorporated by reference in its entirety.

In various aspects, the imaging device 124 includes at least one imagesensor and one or more optical components. Suitable image sensorsinclude, but are not limited to, Charge-Coupled Device (CCD) sensors andComplementary Metal-Oxide Semiconductor (CMOS) sensors.

The optical components of the imaging device 124 may include one or moreillumination sources and/or one or more lenses. The one or moreillumination sources may be directed to illuminate portions of thesurgical field. The one or more image sensors may receive lightreflected or refracted from the surgical field, including lightreflected or refracted from tissue and/or surgical instruments.

The one or more illumination sources may be configured to radiateelectromagnetic energy in the visible spectrum as well as the invisiblespectrum. The visible spectrum, sometimes referred to as the opticalspectrum or luminous spectrum, is that portion of the electromagneticspectrum that is visible to (i.e., can be detected by) the human eye andmay be referred to as visible light or simply light. A typical human eyewill respond to wavelengths in air that are from about 380 nm to about750 nm.

The invisible spectrum (i.e., the non-luminous spectrum) is that portionof the electromagnetic spectrum that lies below and above the visiblespectrum (i.e., wavelengths below about 380 nm and above about 750 nm).The invisible spectrum is not detectable by the human eye. Wavelengthsgreater than about 750 nm are longer than the red visible spectrum, andthey become invisible infrared (IR), microwave, and radioelectromagnetic radiation. Wavelengths less than about 380 nm areshorter than the violet spectrum, and they become invisible ultraviolet,x-ray, and gamma ray electromagnetic radiation.

In various aspects, the imaging device 124 is configured for use in aminimally invasive procedure. Examples of imaging devices suitable foruse with the present disclosure include, but not limited to, anarthroscope, angioscope, bronchoscope, choledochoscope, colonoscope,cytoscope, duodenoscope, enteroscope, esophagogastro-duodenoscope(gastroscope), endoscope, laryngoscope, nasopharyngo-neproscope,sigmoidoscope, thoracoscope, and ureteroscope.

In one aspect, the imaging device employs multi-spectrum monitoring todiscriminate topography and underlying structures. A multi-spectralimage is one that captures image data within specific wavelength rangesacross the electromagnetic spectrum. The wavelengths may be separated byfilters or by the use of instruments that are sensitive to particularwavelengths, including light from frequencies beyond the visible lightrange, e.g., IR and ultraviolet. Spectral imaging can allow extractionof additional information the human eye fails to capture with itsreceptors for red, green, and blue. The use of multi-spectral imaging isdescribed in greater detail under the heading “Advanced ImagingAcquisition Module” in U.S. Provisional Patent Application Ser. No.62/611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017,the disclosure of which is herein incorporated by reference in itsentirety. Multi-spectrum monitoring can be a useful tool in relocating asurgical field after a surgical task is completed to perform one or moreof the previously described tests on the treated tissue.

It is axiomatic that strict sterilization of the operating room andsurgical equipment is required during any surgery. The strict hygieneand sterilization conditions required in a “surgical theater,” i.e., anoperating or treatment room, necessitate the highest possible sterilityof all medical devices and equipment. Part of that sterilization processis the need to sterilize anything that comes in contact with the patientor penetrates the sterile field, including the imaging device 124 andits attachments and components. It will be appreciated that the sterilefield may be considered a specified area, such as within a tray or on asterile towel, that is considered free of microorganisms, or the sterilefield may be considered an area, immediately around a patient, who hasbeen prepared for a surgical procedure. The sterile field may includethe scrubbed team members, who are properly attired, and all furnitureand fixtures in the area.

In various aspects, the visualization system 108 includes one or moreimaging sensors, one or more image-processing units, one or more storagearrays, and one or more displays that are strategically arranged withrespect to the sterile field, as illustrated in FIG. 2 . In one aspect,the visualization system 108 includes an interface for HL7, PACS, andEMR. Various components of the visualization system 108 are describedunder the heading “Advanced Imaging Acquisition Module” in U.S.Provisional Patent Application Ser. No. 62/611,341, entitled INTERACTIVESURGICAL PLATFORM, filed Dec. 28, 2017, the disclosure of which isherein incorporated by reference in its entirety.

As illustrated in FIG. 2 , a primary display 119 is positioned in thesterile field to be visible to an operator at the operating table 114.In addition, a visualization tower 111 is positioned outside the sterilefield. The visualization tower 111 includes a first non-sterile display107 and a second non-sterile display 109, which face away from eachother. The visualization system 108, guided by the hub 106, isconfigured to utilize the displays 107, 109, and 119 to coordinateinformation flow to operators inside and outside the sterile field. Forexample, the hub 106 may cause the visualization system 108 to display asnapshot of a surgical site, as recorded by an imaging device 124, on anon-sterile display 107 or 109, while maintaining a live feed of thesurgical site on the primary display 119. The snapshot on thenon-sterile display 107 or 109 can permit a non-sterile operator toperform a diagnostic step relevant to the surgical procedure, forexample.

In one aspect, the hub 106 is also configured to route a diagnosticinput or feedback entered by a non-sterile operator at the visualizationtower 111 to the primary display 119 within the sterile field, where itcan be viewed by a sterile operator at the operating table. In oneexample, the input can be in the form of a modification to the snapshotdisplayed on the non-sterile display 107 or 109, which can be routed tothe primary display 119 by the hub 106.

Referring to FIG. 2 , a surgical instrument 112 is being used in thesurgical procedure as part of the surgical system 102. The hub 106 isalso configured to coordinate information flow to a display of thesurgical instrument 112. For example, in U.S. Provisional PatentApplication Ser. No. 62/611,341, entitled INTERACTIVE SURGICAL PLATFORM,filed Dec. 28, 2017, the disclosure of which is herein incorporated byreference in its entirety. A diagnostic input or feedback entered by anon-sterile operator at the visualization tower 111 can be routed by thehub 106 to the surgical instrument display 115 within the sterile field,where it can be viewed by the operator of the surgical instrument 112.Example surgical instruments that are suitable for use with the surgicalsystem 102 are described under the heading “Surgical InstrumentHardware” and in U.S. Provisional Patent Application Ser. No.62/611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017,the disclosure of which is herein incorporated by reference in itsentirety, for example.

Referring now to FIG. 3 , a hub 106 is depicted in communication with avisualization system 108, a robotic system 110, and a handheldintelligent surgical instrument 112. The hub 106 includes a hub display135, an imaging module 138, a generator module 140, a communicationmodule 130, a processor module 132, and a storage array 134. In certainaspects, as illustrated in FIG. 3 , the hub 106 further includes a smokeevacuation module 126 and/or a suction/irrigation module 128.

During a surgical procedure, energy application to tissue, for sealingand/or cutting, is generally associated with smoke evacuation, suctionof excess fluid, and/or irrigation of the tissue. Fluid, power, and/ordata lines from different sources are often entangled during thesurgical procedure. Valuable time can be lost addressing this issueduring a surgical procedure. Detangling the lines may necessitatedisconnecting the lines from their respective modules, which may requireresetting the modules. The hub modular enclosure 136 offers a unifiedenvironment for managing the power, data, and fluid lines, which reducesthe frequency of entanglement between such lines.

Aspects of the present disclosure present a surgical hub for use in asurgical procedure that involves energy application to tissue at asurgical site. The surgical hub includes a hub enclosure and a combogenerator module slidably receivable in a docking station of the hubenclosure. The docking station includes data and power contacts. Thecombo generator module includes two or more of an ultrasonic energygenerator component, a bipolar RF energy generator component, and amonopolar RF energy generator component that are housed in a singleunit. In one aspect, the combo generator module also includes a smokeevacuation component, at least one energy delivery cable for connectingthe combo generator module to a surgical instrument, at least one smokeevacuation component configured to evacuate smoke, fluid, and/orparticulates generated by the application of therapeutic energy to thetissue, and a fluid line extending from the remote surgical site to thesmoke evacuation component.

In one aspect, the fluid line is a first fluid line and a second fluidline extends from the remote surgical site to a suction and irrigationmodule slidably received in the hub enclosure. In one aspect, the hubenclosure comprises a fluid interface.

Certain surgical procedures may require the application of more than oneenergy type to the tissue. One energy type may be more beneficial forcutting the tissue, while another different energy type may be morebeneficial for sealing the tissue. For example, a bipolar generator canbe used to seal the tissue while an ultrasonic generator can be used tocut the sealed tissue. Aspects of the present disclosure present asolution where a hub modular enclosure 136 is configured to accommodatedifferent generators, and facilitate an interactive communicationtherebetween. One of the advantages of the hub modular enclosure 136 isenabling the quick removal and/or replacement of various modules.

Aspects of the present disclosure present a modular surgical enclosurefor use in a surgical procedure that involves energy application totissue. The modular surgical enclosure includes a first energy-generatormodule, configured to generate a first energy for application to thetissue, and a first docking station comprising a first docking port thatincludes first data and power contacts, wherein the firstenergy-generator module is slidably movable into an electricalengagement with the power and data contacts and wherein the firstenergy-generator module is slidably movable out of the electricalengagement with the first power and data contacts,

Further to the above, the modular surgical enclosure also includes asecond energy-generator module configured to generate a second energy,different than the first energy, for application to the tissue, and asecond docking station comprising a second docking port that includessecond data and power contacts, wherein the second energy-generatormodule is slidably movable into an electrical engagement with the powerand data contacts, and wherein the second energy-generator module isslidably movable out of the electrical engagement with the second powerand data contacts.

In addition, the modular surgical enclosure also includes acommunication bus between the first docking port and the second dockingport, configured to facilitate communication between the firstenergy-generator module and the second energy-generator module.

Referring to FIGS. 3-7 , aspects of the present disclosure are presentedfor a hub modular enclosure 136 that allows the modular integration of agenerator module 140, a smoke evacuation module 126, and asuction/irrigation module 128. The hub modular enclosure 136 furtherfacilitates interactive communication between the modules 140, 126, 128.As illustrated in FIG. 5 , the generator module 140 can be a generatormodule with integrated monopolar, bipolar, and ultrasonic componentssupported in a single housing unit 139 slidably insertable into the hubmodular enclosure 136. As illustrated in FIG. 5 , the generator module140 can be configured to connect to a monopolar device 146, a bipolardevice 147, and an ultrasonic device 148. Alternatively, the generatormodule 140 may comprise a series of monopolar, bipolar, and/orultrasonic generator modules that interact through the hub modularenclosure 136. The hub modular enclosure 136 can be configured tofacilitate the insertion of multiple generators and interactivecommunication between the generators docked into the hub modularenclosure 136 so that the generators would act as a single generator.

In one aspect, the hub modular enclosure 136 comprises a modular powerand communication backplane 149 with external and wireless communicationheaders to enable the removable attachment of the modules 140, 126, 128and interactive communication therebetween.

In one aspect, the hub modular enclosure 136 includes docking stations,or drawers, 151, herein also referred to as drawers, which areconfigured to slidably receive the modules 140, 126, 128. FIG. 4illustrates a partial perspective view of a surgical hub enclosure 136,and a combo generator module 145 slidably receivable in a dockingstation 151 of the surgical hub enclosure 136. A docking port 152 withpower and data contacts on a rear side of the combo generator module 145is configured to engage a corresponding docking port 150 with power anddata contacts of a corresponding docking station 151 of the hub modularenclosure 136 as the combo generator module 145 is slid into positionwithin the corresponding docking station 151 of the hub module enclosure136. In one aspect, the combo generator module 145 includes a bipolar,ultrasonic, and monopolar module and a smoke evacuation moduleintegrated together into a single housing unit 139, as illustrated inFIG. 5 .

In various aspects, the smoke evacuation module 126 includes a fluidline 154 that conveys captured/collected smoke and/or fluid away from asurgical site and to, for example, the smoke evacuation module 126.Vacuum suction originating from the smoke evacuation module 126 can drawthe smoke into an opening of a utility conduit at the surgical site. Theutility conduit, coupled to the fluid line, can be in the form of aflexible tube terminating at the smoke evacuation module 126. Theutility conduit and the fluid line define a fluid path extending towardthe smoke evacuation module 126 that is received in the hub enclosure136.

In various aspects, the suction/irrigation module 128 is coupled to asurgical tool comprising an aspiration fluid line and a suction fluidline. In one example, the aspiration and suction fluid lines are in theform of flexible tubes extending from the surgical site toward thesuction/irrigation module 128. One or more drive systems can beconfigured to cause irrigation and aspiration of fluids to and from thesurgical site.

In one aspect, the surgical tool includes a shaft having an end effectorat a distal end thereof and at least one energy treatment associatedwith the end effector, an aspiration tube, and an irrigation tube. Theaspiration tube can have an inlet port at a distal end thereof and theaspiration tube extends through the shaft. Similarly, an irrigation tubecan extend through the shaft and can have an inlet port in proximity tothe energy deliver implement. The energy deliver implement is configuredto deliver ultrasonic and/or RF energy to the surgical site and iscoupled to the generator module 140 by a cable extending initiallythrough the shaft.

The irrigation tube can be in fluid communication with a fluid source,and the aspiration tube can be in fluid communication with a vacuumsource. The fluid source and/or the vacuum source can be housed in thesuction/irrigation module 128. In one example, the fluid source and/orthe vacuum source can be housed in the hub enclosure 136 separately fromthe suction/irrigation module 128. In such example, a fluid interfacecan be configured to connect the suction/irrigation module 128 to thefluid source and/or the vacuum source.

In one aspect, the modules 140, 126, 128 and/or their correspondingdocking stations on the hub modular enclosure 136 may include alignmentfeatures that are configured to align the docking ports of the modulesinto engagement with their counterparts in the docking stations of thehub modular enclosure 136. For example, as illustrated in FIG. 4 , thecombo generator module 145 includes side brackets 155 that areconfigured to slidably engage with corresponding brackets 156 of thecorresponding docking station 151 of the hub modular enclosure 136. Thebrackets cooperate to guide the docking port contacts of the combogenerator module 145 into an electrical engagement with the docking portcontacts of the hub modular enclosure 136.

In some aspects, the drawers 151 of the hub modular enclosure 136 arethe same, or substantially the same size, and the modules are adjustedin size to be received in the drawers 151. For example, the sidebrackets 155 and/or 156 can be larger or smaller depending on the sizeof the module. In other aspects, the drawers 151 are different in sizeand are each designed to accommodate a particular module.

Furthermore, the contacts of a particular module can be keyed forengagement with the contacts of a particular drawer to avoid inserting amodule into a drawer with mismatching contacts.

As illustrated in FIG. 4 , the docking port 150 of one drawer 151 can becoupled to the docking port 150 of another drawer 151 through acommunications link 157 to facilitate an interactive communicationbetween the modules housed in the hub modular enclosure 136. The dockingports 150 of the hub modular enclosure 136 may alternatively, oradditionally, facilitate a wireless interactive communication betweenthe modules housed in the hub modular enclosure 136. Any suitablewireless communication can be employed, such as for example AirTitan-Bluetooth.

FIG. 6 illustrates individual power bus attachments for a plurality oflateral docking ports of a lateral modular housing 160 configured toreceive a plurality of modules of a surgical hub 206. The lateralmodular housing 160 is configured to laterally receive and interconnectthe modules 161. The modules 161 are slidably inserted into dockingstations 162 of lateral modular housing 160, which includes a backplanefor interconnecting the modules 161. As illustrated in FIG. 6 , themodules 161 are arranged laterally in the lateral modular housing 160.Alternatively, the modules 161 may be arranged vertically in a lateralmodular housing.

FIG. 7 illustrates a vertical modular housing 164 configured to receivea plurality of modules 165 of the surgical hub 106. The modules 165 areslidably inserted into docking stations, or drawers, 167 of verticalmodular housing 164, which includes a backplane for interconnecting themodules 165. Although the drawers 167 of the vertical modular housing164 are arranged vertically, in certain instances, a vertical modularhousing 164 may include drawers that are arranged laterally.Furthermore, the modules 165 may interact with one another through thedocking ports of the vertical modular housing 164. In the example ofFIG. 7 , a display 177 is provided for displaying data relevant to theoperation of the modules 165. In addition, the vertical modular housing164 includes a master module 178 housing a plurality of sub-modules thatare slidably received in the master module 178.

In various aspects, the imaging module 138 comprises an integrated videoprocessor and a modular light source and is adapted for use with variousimaging devices. In one aspect, the imaging device is comprised of amodular housing that can be assembled with a light source module and acamera module. The housing can be a disposable housing. In at least oneexample, the disposable housing is removably coupled to a reusablecontroller, a light source module, and a camera module. The light sourcemodule and/or the camera module can be selectively chosen depending onthe type of surgical procedure. In one aspect, the camera modulecomprises a CCD sensor. In another aspect, the camera module comprises aCMOS sensor. In another aspect, the camera module is configured forscanned beam imaging. Likewise, the light source module can beconfigured to deliver a white light or a different light, depending onthe surgical procedure.

During a surgical procedure, removing a surgical device from thesurgical field and replacing it with another surgical device thatincludes a different camera or a different light source can beinefficient. Temporarily losing sight of the surgical field may lead toundesirable consequences. The module imaging device of the presentdisclosure is configured to permit the replacement of a light sourcemodule or a camera module midstream during a surgical procedure, withouthaving to remove the imaging device from the surgical field.

In one aspect, the imaging device comprises a tubular housing thatincludes a plurality of channels. A first channel is configured toslidably receive the camera module, which can be configured for asnap-fit engagement with the first channel. A second channel isconfigured to slidably receive the light source module, which can beconfigured for a snap-fit engagement with the second channel. In anotherexample, the camera module and/or the light source module can be rotatedinto a final position within their respective channels. A threadedengagement can be employed in lieu of the snap-fit engagement.

In various examples, multiple imaging devices are placed at differentpositions in the surgical field to provide multiple views. The imagingmodule 138 can be configured to switch between the imaging devices toprovide an optimal view. In various aspects, the imaging module 138 canbe configured to integrate the images from the different imaging device.

Various image processors and imaging devices suitable for use with thepresent disclosure are described in U.S. Pat. No. 7,995,045, entitledCOMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR, which issued on Aug. 9,2011, which is herein incorporated by reference in its entirety. Inaddition, U.S. Pat. No. 7,982,776, entitled SBI MOTION ARTIFACT REMOVALAPPARATUS AND METHOD, which issued on Jul. 19, 2011, which is hereinincorporated by reference in its entirety, describes various systems forremoving motion artifacts from image data. Such systems can beintegrated with the imaging module 138. Furthermore, U.S. PatentApplication Publication No. 2011/0306840, entitled CONTROLLABLE MAGNETICSOURCE TO FIXTURE INTRACORPOREAL APPARATUS, which published on Dec. 15,2011, and U.S. Patent Application Publication No. 2014/0243597, entitledSYSTEM FOR PERFORMING A MINIMALLY INVASIVE SURGICAL PROCEDURE, whichpublished on Aug. 28, 2014, each of which is herein incorporated byreference in its entirety.

FIG. 8 illustrates a surgical data network 201 comprising a modularcommunication hub 203 configured to connect modular devices located inone or more operating theaters of a healthcare facility, or any room ina healthcare facility specially equipped for surgical operations, to acloud-based system (e.g., the cloud 204 that may include a remote server213 coupled to a storage device 205). In one aspect, the modularcommunication hub 203 comprises a network hub 207 and/or a networkswitch 209 in communication with a network router. The modularcommunication hub 203 also can be coupled to a local computer system 210to provide local computer processing and data manipulation. The surgicaldata network 201 may be configured as passive, intelligent, orswitching. A passive surgical data network serves as a conduit for thedata, enabling it to go from one device (or segment) to another and tothe cloud computing resources. An intelligent surgical data networkincludes additional features to enable the traffic passing through thesurgical data network to be monitored and to configure each port in thenetwork hub 207 or network switch 209. An intelligent surgical datanetwork may be referred to as a manageable hub or switch. A switchinghub reads the destination address of each packet and then forwards thepacket to the correct port.

Modular devices 1 a-1 n located in the operating theater may be coupledto the modular communication hub 203. The network hub 207 and/or thenetwork switch 209 may be coupled to a network router 211 to connect thedevices 1 a-1 n to the cloud 204 or the local computer system 210. Dataassociated with the devices 1 a-1 n may be transferred to cloud-basedcomputers via the router for remote data processing and manipulation.Data associated with the devices 1 a-1 n may also be transferred to thelocal computer system 210 for local data processing and manipulation.Modular devices 2 a-2 m located in the same operating theater also maybe coupled to a network switch 209. The network switch 209 may becoupled to the network hub 207 and/or the network router 211 to connectto the devices 2 a-2 m to the cloud 204. Data associated with thedevices 2 a-2 n may be transferred to the cloud 204 via the networkrouter 211 for data processing and manipulation. Data associated withthe devices 2 a-2 m may also be transferred to the local computer system210 for local data processing and manipulation.

It will be appreciated that the surgical data network 201 may beexpanded by interconnecting multiple network hubs 207 and/or multiplenetwork switches 209 with multiple network routers 211. The modularcommunication hub 203 may be contained in a modular control towerconfigured to receive multiple devices 1 a-1 n/2 a-2 m. The localcomputer system 210 also may be contained in a modular control tower.The modular communication hub 203 is connected to a display 212 todisplay images obtained by some of the devices 1 a-1 n/2 a-2 m, forexample during surgical procedures. In various aspects, the devices 1a-1 n/2 a-2 m may include, for example, various modules such as animaging module 138 coupled to an endoscope, a generator module 140coupled to an energy-based surgical device, a smoke evacuation module126, a suction/irrigation module 128, a communication module 130, aprocessor module 132, a storage array 134, a surgical device coupled toa display, and/or a non-contact sensor module, among other modulardevices that may be connected to the modular communication hub 203 ofthe surgical data network 201.

In one aspect, the surgical data network 201 may comprise a combinationof network hub(s), network switch(es), and network router(s) connectingthe devices 1 a-1 n/2 a-2 m to the cloud. Any one of or all of thedevices 1 a-1 n/2 a-2 m coupled to the network hub or network switch maycollect data in real time and transfer the data to cloud computers fordata processing and manipulation. It will be appreciated that cloudcomputing relies on sharing computing resources rather than having localservers or personal devices to handle software applications. The word“cloud” may be used as a metaphor for “the Internet,” although the termis not limited as such. Accordingly, the term “cloud computing” may beused herein to refer to “a type of Internet-based computing,” wheredifferent services—such as servers, storage, and applications—aredelivered to the modular communication hub 203 and/or computer system210 located in the surgical theater (e.g., a fixed, mobile, temporary,or field operating room or space) and to devices connected to themodular communication hub 203 and/or computer system 210 through theInternet. The cloud infrastructure may be maintained by a cloud serviceprovider. In this context, the cloud service provider may be the entitythat coordinates the usage and control of the devices 1 a-1 n/2 a-2 mlocated in one or more operating theaters. The cloud computing servicescan perform a large number of calculations based on the data gathered bysmart surgical instruments, robots, and other computerized deviceslocated in the operating theater. The hub hardware enables multipledevices or connections to be connected to a computer that communicateswith the cloud computing resources and storage.

Applying cloud computer data processing techniques on the data collectedby the devices 1 a-1 n/2 a-2 m, the surgical data network providesimproved surgical outcomes, reduced costs, and improved patientsatisfaction. At least some of the devices 1 a-1 n/2 a-2 m may beemployed to view tissue states to assess leaks or perfusion of sealedtissue after a tissue sealing and cutting procedure. At least some ofthe devices 1 a-1 n/2 a-2 m may be employed to identify pathology, suchas the effects of diseases, using the cloud-based computing to examinedata including images of samples of body tissue for diagnostic purposes.This includes localization and margin confirmation of tissue andphenotypes. At least some of the devices 1 a-1 n/2 a-2 m may be employedto identify anatomical structures of the body using a variety of sensorsintegrated with imaging devices and techniques such as overlaying imagescaptured by multiple imaging devices. The data gathered by the devices 1a-1 n/2 a-2 m, including image data, may be transferred to the cloud 204or the local computer system 210 or both for data processing andmanipulation including image processing and manipulation. The data maybe analyzed to improve surgical procedure outcomes by determining iffurther treatment, such as the application of endoscopic intervention,emerging technologies, a targeted radiation, targeted intervention, andprecise robotics to tissue-specific sites and conditions, may bepursued. Such data analysis may further employ outcome analyticsprocessing, and using standardized approaches may provide beneficialfeedback to either confirm surgical treatments and the behavior of thesurgeon or suggest modifications to surgical treatments and the behaviorof the surgeon.

In one implementation, the operating theater devices 1 a-1 n may beconnected to the modular communication hub 203 over a wired channel or awireless channel depending on the configuration of the devices 1 a-1 nto a network hub. The network hub 207 may be implemented, in one aspect,as a local network broadcast device that works on the physical layer ofthe Open System Interconnection (OSI) model. The network hub providesconnectivity to the devices 1 a-1 n located in the same operatingtheater network. The network hub 207 collects data in the form ofpackets and sends them to the router in half duplex mode. The networkhub 207 does not store any media access control/Internet Protocol(MAC/IP) to transfer the device data. Only one of the devices 1 a-1 ncan send data at a time through the network hub 207. The network hub 207has no routing tables or intelligence regarding where to sendinformation and broadcasts all network data across each connection andto a remote server 213 (FIG. 9 ) over the cloud 204. The network hub 207can detect basic network errors such as collisions, but having allinformation broadcast to multiple ports can be a security risk and causebottlenecks.

In another implementation, the operating theater devices 2 a-2 m may beconnected to a network switch 209 over a wired channel or a wirelesschannel. The network switch 209 works in the data link layer of the OSImodel. The network switch 209 is a multicast device for connecting thedevices 2 a-2 m located in the same operating theater to the network.The network switch 209 sends data in the form of frames to the networkrouter 211 and works in full duplex mode. Multiple devices 2 a-2 m cansend data at the same time through the network switch 209. The networkswitch 209 stores and uses MAC addresses of the devices 2 a-2 m totransfer data.

The network hub 207 and/or the network switch 209 are coupled to thenetwork router 211 for connection to the cloud 204. The network router211 works in the network layer of the OSI model. The network router 211creates a route for transmitting data packets received from the networkhub 207 and/or network switch 211 to cloud-based computer resources forfurther processing and manipulation of the data collected by any one ofor all the devices 1 a-1 n/2 a-2 m. The network router 211 may beemployed to connect two or more different networks located in differentlocations, such as, for example, different operating theaters of thesame healthcare facility or different networks located in differentoperating theaters of different healthcare facilities. The networkrouter 211 sends data in the form of packets to the cloud 204 and worksin full duplex mode. Multiple devices can send data at the same time.The network router 211 uses IP addresses to transfer data.

In one example, the network hub 207 may be implemented as a USB hub,which allows multiple USB devices to be connected to a host computer.The USB hub may expand a single USB port into several tiers so thatthere are more ports available to connect devices to the host systemcomputer. The network hub 207 may include wired or wireless capabilitiesto receive information over a wired channel or a wireless channel. Inone aspect, a wireless USB short-range, high-bandwidth wireless radiocommunication protocol may be employed for communication between thedevices 1 a-1 n and devices 2 a-2 m located in the operating theater.

In other examples, the operating theater devices 1 a-1 n/2 a-2 m maycommunicate to the modular communication hub 203 via Bluetooth wirelesstechnology standard for exchanging data over short distances (usingshort-wavelength UHF radio waves in the ISM band from 2.4 to 2.485 GHz)from fixed and mobile devices and building personal area networks(PANs). In other aspects, the operating theater devices 1 a-1 n/2 a-2 mmay communicate to the modular communication hub 203 via a number ofwireless or wired communication standards or protocols, including butnot limited to Wi-Fi (IEEE 802.11 family), WiMAX (IEEE 802.16 family),IEEE 802.20, long-term evolution (LTE), and Ev-DO, HSPA+, HSDPA+,HSUPA+, EDGE, GSM, GPRS, CDMA, TDMA, DECT, and Ethernet derivativesthereof, as well as any other wireless and wired protocols that aredesignated as 3G, 4G, 5G, and beyond. The computing module may include aplurality of communication modules. For instance, a first communicationmodule may be dedicated to shorter-range wireless communications such asWi-Fi and Bluetooth, and a second communication module may be dedicatedto longer-range wireless communications such as GPS, EDGE, GPRS, CDMA,WiMAX, LTE, Ev-DO, and others.

The modular communication hub 203 may serve as a central connection forone or all of the operating theater devices 1 a-1 n/2 a-2 m and handlesa data type known as frames. Frames carry the data generated by thedevices 1 a-1 n/2 a-2 m. When a frame is received by the modularcommunication hub 203, it is amplified and transmitted to the networkrouter 211, which transfers the data to the cloud computing resources byusing a number of wireless or wired communication standards orprotocols, as described herein.

The modular communication hub 203 can be used as a standalone device orbe connected to compatible network hubs and network switches to form alarger network. The modular communication hub 203 is generally easy toinstall, configure, and maintain, making it a good option for networkingthe operating theater devices 1 a-1 n/2 a-2 m.

FIG. 9 illustrates a computer-implemented interactive surgical system200. The computer-implemented interactive surgical system 200 is similarin many respects to the computer-implemented interactive surgical system100. For example, the computer-implemented interactive surgical system200 includes one or more surgical systems 202, which are similar in manyrespects to the surgical systems 102. Each surgical system 202 includesat least one surgical hub 206 in communication with a cloud 204 that mayinclude a remote server 213. In one aspect, the computer-implementedinteractive surgical system 200 comprises a modular control tower 236connected to multiple operating theater devices such as, for example,intelligent surgical instruments, robots, and other computerized deviceslocated in the operating theater. As shown in FIG. 10 , the modularcontrol tower 236 comprises a modular communication hub 203 coupled to acomputer system 210. As illustrated in the example of FIG. 9 , themodular control tower 236 is coupled to an imaging module 238 that iscoupled to an endoscope 239, a generator module 240 that is coupled toan energy device 241, a smoke evacuator module 226, a suction/irrigationmodule 228, a communication module 230, a processor module 232, astorage array 234, a smart device/instrument 235 optionally coupled to adisplay 237, and a non-contact sensor module 242. The operating theaterdevices are coupled to cloud computing resources and data storage viathe modular control tower 236. A robot hub 222 also may be connected tothe modular control tower 236 and to the cloud computing resources. Thedevices/instruments 235, visualization systems 208, among others, may becoupled to the modular control tower 236 via wired or wirelesscommunication standards or protocols, as described herein. The modularcontrol tower 236 may be coupled to a hub display 215 (e.g., monitor,screen) to display and overlay images received from the imaging module,device/instrument display, and/or other visualization systems 208. Thehub display also may display data received from devices connected to themodular control tower in conjunction with images and overlaid images.

FIG. 10 illustrates a surgical hub 206 comprising a plurality of modulescoupled to the modular control tower 236. The modular control tower 236comprises a modular communication hub 203, e.g., a network connectivitydevice, and a computer system 210 to provide local processing,visualization, and imaging, for example. As shown in FIG. 10 , themodular communication hub 203 may be connected in a tiered configurationto expand the number of modules (e.g., devices) that may be connected tothe modular communication hub 203 and transfer data associated with themodules to the computer system 210, cloud computing resources, or both.As shown in FIG. 10 , each of the network hubs/switches in the modularcommunication hub 203 includes three downstream ports and one upstreamport. The upstream network hub/switch is connected to a processor toprovide a communication connection to the cloud computing resources anda local display 217. Communication to the cloud 204 may be made eitherthrough a wired or a wireless communication channel.

The surgical hub 206 employs a non-contact sensor module 242 to measurethe dimensions of the operating theater and generate a map of thesurgical theater using either ultrasonic or laser-type non-contactmeasurement devices. An ultrasound-based non-contact sensor module scansthe operating theater by transmitting a burst of ultrasound andreceiving the echo when it bounces off the perimeter walls of anoperating theater as described under the heading “Surgical Hub SpatialAwareness Within an Operating Room” in U.S. Provisional PatentApplication Ser. No. 62/611,341, entitled INTERACTIVE SURGICAL PLATFORM,filed Dec. 28, 2017, which is herein incorporated by reference in itsentirety, in which the sensor module is configured to determine the sizeof the operating theater and to adjust Bluetooth-pairing distancelimits. A laser-based non-contact sensor module scans the operatingtheater by transmitting laser light pulses, receiving laser light pulsesthat bounce off the perimeter walls of the operating theater, andcomparing the phase of the transmitted pulse to the received pulse todetermine the size of the operating theater and to adjust Bluetoothpairing distance limits, for example.

The computer system 210 comprises a processor 244 and a networkinterface 245. The processor 244 is coupled to a communication module247, storage 248, memory 249, non-volatile memory 250, and input/outputinterface 251 via a system bus. The system bus can be any of severaltypes of bus structure(s) including the memory bus or memory controller,a peripheral bus or external bus, and/or a local bus using any varietyof available bus architectures including, but not limited to, 9-bit bus,Industrial Standard Architecture (ISA), Micro-Charmel Architecture(MSA), Extended ISA (EISA), Intelligent Drive Electronics (IDE), VESALocal Bus (VLB), Peripheral Component Interconnect (PCI), USB, AdvancedGraphics Port (AGP), Personal Computer Memory Card InternationalAssociation bus (PCMCIA), Small Computer Systems Interface (SCSI), orany other proprietary bus.

The processor 244 may be any single-core or multicore processor such asthose known under the trade name ARM Cortex by Texas Instruments. In oneaspect, the processor may be an LM4F230H5QR ARM Cortex-M4F ProcessorCore, available from Texas Instruments, for example, comprising anon-chip memory of 256 KB single-cycle flash memory, or othernon-volatile memory, up to 40 MHz, a prefetch buffer to improveperformance above 40 MHz, a 32 KB single-cycle serial random accessmemory (SRAM), an internal read-only memory (ROM) loaded withStellarisWare® software, a 2 KB electrically erasable programmableread-only memory (EEPROM), and/or one or more pulse width modulation(PWM) modules, one or more quadrature encoder inputs (QEI) analogs, oneor more 12-bit analog-to-digital converters (ADCs) with 12 analog inputchannels, details of which are available for the product datasheet.

In one aspect, the processor 244 may comprise a safety controllercomprising two controller-based families such as TMS570 and RM4x, knownunder the trade name Hercules ARM Cortex R4, also by Texas Instruments.The safety controller may be configured specifically for IEC 61508 andISO 26262 safety critical applications, among others, to provideadvanced integrated safety features while delivering scalableperformance, connectivity, and memory options.

The system memory includes volatile memory and non-volatile memory. Thebasic input/output system (BIOS), containing the basic routines totransfer information between elements within the computer system, suchas during start-up, is stored in non-volatile memory. For example, thenon-volatile memory can include ROM, programmable ROM (PROM),electrically programmable ROM (EPROM), EEPROM, or flash memory. Volatilememory includes random-access memory (RAM), which acts as external cachememory. Moreover, RAM is available in many forms such as SRAM, dynamicRAM (DRAM), synchronous DRAM (SDRAM), double data rate SDRAM (DDRSDRAM), enhanced SDRAM (ESDRAM), Synchlink DRAM (SLDRAM), and directRambus RAM (DRRAM).

The computer system 210 also includes removable/non-removable,volatile/non-volatile computer storage media, such as for example diskstorage. The disk storage includes, but is not limited to, devices likea magnetic disk drive, floppy disk drive, tape drive, Jaz drive, Zipdrive, LS-60 drive, flash memory card, or memory stick. In addition, thedisk storage can include storage media separately or in combination withother storage media including, but not limited to, an optical disc drivesuch as a compact disc ROM device (CD-ROM), compact disc recordabledrive (CD-R Drive), compact disc rewritable drive (CD-RW Drive), or adigital versatile disc ROM drive (DVD-ROM). To facilitate the connectionof the disk storage devices to the system bus, a removable ornon-removable interface may be employed.

It is to be appreciated that the computer system 210 includes softwarethat acts as an intermediary between users and the basic computerresources described in a suitable operating environment. Such softwareincludes an operating system. The operating system, which can be storedon the disk storage, acts to control and allocate resources of thecomputer system. System applications take advantage of the management ofresources by the operating system through program modules and programdata stored either in the system memory or on the disk storage. It is tobe appreciated that various components described herein can beimplemented with various operating systems or combinations of operatingsystems.

A user enters commands or information into the computer system 210through input device(s) coupled to the I/O interface 251. The inputdevices include, but are not limited to, a pointing device such as amouse, trackball, stylus, touch pad, keyboard, microphone, joystick,game pad, satellite dish, scanner, TV tuner card, digital camera,digital video camera, web camera, and the like. These and other inputdevices connect to the processor through the system bus via interfaceport(s). The interface port(s) include, for example, a serial port, aparallel port, a game port, and a USB. The output device(s) use some ofthe same types of ports as input device(s). Thus, for example, a USBport may be used to provide input to the computer system and to outputinformation from the computer system to an output device. An outputadapter is provided to illustrate that there are some output deviceslike monitors, displays, speakers, and printers, among other outputdevices that require special adapters. The output adapters include, byway of illustration and not limitation, video and sound cards thatprovide a means of connection between the output device and the systembus. It should be noted that other devices and/or systems of devices,such as remote computer(s), provide both input and output capabilities.

The computer system 210 can operate in a networked environment usinglogical connections to one or more remote computers, such as cloudcomputer(s), or local computers. The remote cloud computer(s) can be apersonal computer, server, router, network PC, workstation,microprocessor-based appliance, peer device, or other common networknode, and the like, and typically includes many or all of the elementsdescribed relative to the computer system. For purposes of brevity, onlya memory storage device is illustrated with the remote computer(s). Theremote computer(s) is logically connected to the computer system througha network interface and then physically connected via a communicationconnection. The network interface encompasses communication networkssuch as local area networks (LANs) and wide area networks (WANs). LANtechnologies include Fiber Distributed Data Interface (FDDI), CopperDistributed Data Interface (CDDI), Ethernet/IEEE 802.3, Token Ring/IEEE802.5 and the like. WAN technologies include, but are not limited to,point-to-point links, circuit-switching networks like IntegratedServices Digital Networks (ISDN) and variations thereon,packet-switching networks, and Digital Subscriber Lines (DSL).

In various aspects, the computer system 210 of FIG. 10 , the imagingmodule 238 and/or visualization system 208, and/or the processor module232 of FIGS. 9-10 , may comprise an image processor, image-processingengine, media processor, or any specialized digital signal processor(DSP) used for the processing of digital images. The image processor mayemploy parallel computing with single instruction, multiple data (SIMD)or multiple instruction, multiple data (MIMD) technologies to increasespeed and efficiency. The digital image-processing engine can perform arange of tasks. The image processor may be a system on a chip withmulticore processor architecture.

The communication connection(s) refers to the hardware/software employedto connect the network interface to the bus. While the communicationconnection is shown for illustrative clarity inside the computer system,it can also be external to the computer system 210. Thehardware/software necessary for connection to the network interfaceincludes, for illustrative purposes only, internal and externaltechnologies such as modems, including regular telephone-grade modems,cable modems, and DSL modems, ISDN adapters, and Ethernet cards.

FIG. 11 illustrates a functional block diagram of one aspect of a USBnetwork hub 300 device, according to one aspect of the presentdisclosure. In the illustrated aspect, the USB network hub device 300employs a TUSB2036 integrated circuit hub by Texas Instruments. The USBnetwork hub 300 is a CMOS device that provides an upstream USBtransceiver port 302 and up to three downstream USB transceiver ports304, 306, 308 in compliance with the USB 2.0 specification. The upstreamUSB transceiver port 302 is a differential root data port comprising adifferential data minus (DM0) input paired with a differential data plus(DP0) input. The three downstream USB transceiver ports 304, 306, 308are differential data ports where each port includes differential dataplus (DP1-DP3) outputs paired with differential data minus (DM1-DM3)outputs.

The USB network hub 300 device is implemented with a digital statemachine instead of a microcontroller, and no firmware programming isrequired. Fully compliant USB transceivers are integrated into thecircuit for the upstream USB transceiver port 302 and all downstream USBtransceiver ports 304, 306, 308. The downstream USB transceiver ports304, 306, 308 support both full-speed and low-speed devices byautomatically setting the slew rate according to the speed of the deviceattached to the ports. The USB network hub 300 device may be configuredeither in bus-powered or self-powered mode and includes a hub powerlogic 312 to manage power.

The USB network hub 300 device includes a serial interface engine 310(SIE). The SIE 310 is the front end of the USB network hub 300 hardwareand handles most of the protocol described in chapter 8 of the USBspecification. The SIE 310 typically comprehends signaling up to thetransaction level. The functions that it handles could include: packetrecognition, transaction sequencing, SOP, EOP, RESET, and RESUME signaldetection/generation, clock/data separation, non-return-to-zero invert(NRZI) data encoding/decoding and bit-stuffing, CRC generation andchecking (token and data), packet ID (PID) generation andchecking/decoding, and/or serial-parallel/parallel-serial conversion.The 310 receives a clock input 314 and is coupled to a suspend/resumelogic and frame timer 316 circuit and a hub repeater circuit 318 tocontrol communication between the upstream USB transceiver port 302 andthe downstream USB transceiver ports 304, 306, 308 through port logiccircuits 320, 322, 324. The SIE 310 is coupled to a command decoder 326via interface logic to control commands from a serial EEPROM via aserial EEPROM interface 330.

In various aspects, the USB network hub 300 can connect 127 functionsconfigured in up to six logical layers (tiers) to a single computer.Further, the USB network hub 300 can connect to all peripherals using astandardized four-wire cable that provides both communication and powerdistribution. The power configurations are bus-powered and self-poweredmodes. The USB network hub 300 may be configured to support four modesof power management: a bus-powered hub, with either individual-portpower management or ganged-port power management, and the self-poweredhub, with either individual-port power management or ganged-port powermanagement. In one aspect, using a USB cable, the USB network hub 300,the upstream USB transceiver port 302 is plugged into a USB hostcontroller, and the downstream USB transceiver ports 304, 306, 308 areexposed for connecting USB compatible devices, and so forth.

Surgical Instrument Hardware

FIG. 12 illustrates a logic diagram of a control system 470 of asurgical instrument or tool in accordance with one or more aspects ofthe present disclosure. The system 470 comprises a control circuit. Thecontrol circuit includes a microcontroller 461 comprising a processor462 and a memory 468. One or more of sensors 472, 474, 476, for example,provide real-time feedback to the processor 462. A motor 482, driven bya motor driver 492, operably couples a longitudinally movabledisplacement member to drive the I-beam knife element. A tracking system480 is configured to determine the position of the longitudinallymovable displacement member. The position information is provided to theprocessor 462, which can be programmed or configured to determine theposition of the longitudinally movable drive member as well as theposition of a firing member, firing bar, and I-beam knife element.Additional motors may be provided at the tool driver interface tocontrol I-beam firing, closure tube travel, shaft rotation, andarticulation. A display 473 displays a variety of operating conditionsof the instruments and may include touch screen functionality for datainput. Information displayed on the display 473 may be overlaid withimages acquired via endoscopic imaging modules.

In one aspect, the microcontroller 461 may be any single-core ormulticore processor such as those known under the trade name ARM Cortexby Texas Instruments. In one aspect, the main microcontroller 461 may bean LM4F230H5QR ARM Cortex-M4F Processor Core, available from TexasInstruments, for example, comprising an on-chip memory of 256 KBsingle-cycle flash memory, or other non-volatile memory, up to 40 MHz, aprefetch buffer to improve performance above 40 MHz, a 32 KBsingle-cycle SRAM, and internal ROM loaded with StellarisWare® software,a 2 KB EEPROM, one or more PWM modules, one or more QEI analogs, and/orone or more 12-bit ADCs with 12 analog input channels, details of whichare available for the product datasheet.

In one aspect, the microcontroller 461 may comprise a safety controllercomprising two controller-based families such as TMS570 and RM4x, knownunder the trade name Hercules ARM Cortex R4, also by Texas Instruments.The safety controller may be configured specifically for IEC 61508 andISO 26262 safety critical applications, among others, to provideadvanced integrated safety features while delivering scalableperformance, connectivity, and memory options.

The microcontroller 461 may be programmed to perform various functionssuch as precise control over the speed and position of the knife andarticulation systems. In one aspect, the microcontroller 461 includes aprocessor 462 and a memory 468. The electric motor 482 may be a brusheddirect current (DC) motor with a gearbox and mechanical links to anarticulation or knife system. In one aspect, a motor driver 492 may bean A3941 available from Allegro Microsystems, Inc. Other motor driversmay be readily substituted for use in the tracking system 480 comprisingan absolute positioning system. A detailed description of an absolutepositioning system is described in U.S. Patent Application PublicationNo. 2017/0296213, entitled SYSTEMS AND METHODS FOR CONTROLLING ASURGICAL STAPLING AND CUTTING INSTRUMENT, which published on Oct. 19,2017, which is herein incorporated by reference in its entirety.

The microcontroller 461 may be programmed to provide precise controlover the speed and position of displacement members and articulationsystems. The microcontroller 461 may be configured to compute a responsein the software of the microcontroller 461. The computed response iscompared to a measured response of the actual system to obtain an“observed” response, which is used for actual feedback decisions. Theobserved response is a favorable, tuned value that balances the smooth,continuous nature of the simulated response with the measured response,which can detect outside influences on the system.

In one aspect, the motor 482 may be controlled by the motor driver 492and can be employed by the firing system of the surgical instrument ortool. In various forms, the motor 482 may be a brushed DC driving motorhaving a maximum rotational speed of approximately 25,000 RPM. In otherarrangements, the motor 482 may include a brushless motor, a cordlessmotor, a synchronous motor, a stepper motor, or any other suitableelectric motor. The motor driver 492 may comprise an H-bridge drivercomprising field-effect transistors (FETs), for example. The motor 482can be powered by a power assembly releasably mounted to the handleassembly or tool housing for supplying control power to the surgicalinstrument or tool. The power assembly may comprise a battery which mayinclude a number of battery cells connected in series that can be usedas the power source to power the surgical instrument or tool. In certaincircumstances, the battery cells of the power assembly may bereplaceable and/or rechargeable. In at least one example, the batterycells can be lithium-ion batteries which can be couplable to andseparable from the power assembly.

The motor driver 492 may be an A3941 available from AllegroMicrosystems, Inc. The A3941 492 is a full-bridge controller for usewith external N-channel power metal-oxide semiconductor field-effecttransistors (MOSFETs) specifically designed for inductive loads, such asbrush DC motors. The driver 492 comprises a unique charge pump regulatorthat provides full (>10 V) gate drive for battery voltages down to 7 Vand allows the A3941 to operate with a reduced gate drive, down to 5.5V. A bootstrap capacitor may be employed to provide the above batterysupply voltage required for N-channel MOSFETs. An internal charge pumpfor the high-side drive allows DC (100% duty cycle) operation. The fullbridge can be driven in fast or slow decay modes using diode orsynchronous rectification. In the slow decay mode, current recirculationcan be through the high-side or the lowside FETs. The power FETs areprotected from shoot-through by resistor-adjustable dead time.Integrated diagnostics provide indications of undervoltage,overtemperature, and power bridge faults and can be configured toprotect the power MOSFETs under most short circuit conditions. Othermotor drivers may be readily substituted for use in the tracking system480 comprising an absolute positioning system.

The tracking system 480 comprises a controlled motor drive circuitarrangement comprising a position sensor 472 according to one aspect ofthis disclosure. The position sensor 472 for an absolute positioningsystem provides a unique position signal corresponding to the locationof a displacement member. In one aspect, the displacement memberrepresents a longitudinally movable drive member comprising a rack ofdrive teeth for meshing engagement with a corresponding drive gear of agear reducer assembly. In other aspects, the displacement memberrepresents the firing member, which could be adapted and configured toinclude a rack of drive teeth. In yet another aspect, the displacementmember represents a firing bar or the I-beam, each of which can beadapted and configured to include a rack of drive teeth. Accordingly, asused herein, the term displacement member is used generically to referto any movable member of the surgical instrument or tool such as thedrive member, the firing member, the firing bar, the I-beam, or anyelement that can be displaced. In one aspect, the longitudinally movabledrive member is coupled to the firing member, the firing bar, and theI-beam. Accordingly, the absolute positioning system can, in effect,track the linear displacement of the I-beam by tracking the lineardisplacement of the longitudinally movable drive member. In variousother aspects, the displacement member may be coupled to any positionsensor 472 suitable for measuring linear displacement. Thus, thelongitudinally movable drive member, the firing member, the firing bar,or the I-beam, or combinations thereof, may be coupled to any suitablelinear displacement sensor. Linear displacement sensors may includecontact or non-contact displacement sensors. Linear displacement sensorsmay comprise linear variable differential transformers (LVDT),differential variable reluctance transducers (DVRT), a slidepotentiometer, a magnetic sensing system comprising a movable magnet anda series of linearly arranged Hall effect sensors, a magnetic sensingsystem comprising a fixed magnet and a series of movable, linearlyarranged Hall effect sensors, an optical sensing system comprising amovable light source and a series of linearly arranged photo diodes orphoto detectors, an optical sensing system comprising a fixed lightsource and a series of movable linearly, arranged photo diodes or photodetectors, or any combination thereof.

The electric motor 482 can include a rotatable shaft that operablyinterfaces with a gear assembly that is mounted in meshing engagementwith a set, or rack, of drive teeth on the displacement member. A sensorelement may be operably coupled to a gear assembly such that a singlerevolution of the position sensor 472 element corresponds to some linearlongitudinal translation of the displacement member. An arrangement ofgearing and sensors can be connected to the linear actuator, via a rackand pinion arrangement, or a rotary actuator, via a spur gear or otherconnection. A power source supplies power to the absolute positioningsystem and an output indicator may display the output of the absolutepositioning system. The displacement member represents thelongitudinally movable drive member comprising a rack of drive teethformed thereon for meshing engagement with a corresponding drive gear ofthe gear reducer assembly. The displacement member represents thelongitudinally movable firing member, firing bar, I-beam, orcombinations thereof.

A single revolution of the sensor element associated with the positionsensor 472 is equivalent to a longitudinal linear displacement d1 of theof the displacement member, where d1 is the longitudinal linear distancethat the displacement member moves from point “a” to point “b” after asingle revolution of the sensor element coupled to the displacementmember. The sensor arrangement may be connected via a gear reductionthat results in the position sensor 472 completing one or morerevolutions for the full stroke of the displacement member. The positionsensor 472 may complete multiple revolutions for the full stroke of thedisplacement member.

A series of switches, where n is an integer greater than one, may beemployed alone or in combination with a gear reduction to provide aunique position signal for more than one revolution of the positionsensor 472. The state of the switches are fed back to themicrocontroller 461 that applies logic to determine a unique positionsignal corresponding to the longitudinal linear displacement d1+d2+ . .. dn of the displacement member. The output of the position sensor 472is provided to the microcontroller 461. The position sensor 472 of thesensor arrangement may comprise a magnetic sensor, an analog rotarysensor like a potentiometer, or an array of analog Hall-effect elements,which output a unique combination of position signals or values.

The position sensor 472 may comprise any number of magnetic sensingelements, such as, for example, magnetic sensors classified according towhether they measure the total magnetic field or the vector componentsof the magnetic field. The techniques used to produce both types ofmagnetic sensors encompass many aspects of physics and electronics. Thetechnologies used for magnetic field sensing include search coil,fluxgate, optically pumped, nuclear precession, SQUID, Hall-effect,anisotropic magnetoresistance, giant magnetoresistance, magnetic tunneljunctions, giant magnetoimpedance, magnetostrictive/piezoelectriccomposites, magnetodiode, magnetotransistor, fiber-optic, magneto-optic,and microelectromechanical systems-based magnetic sensors, among others.

In one aspect, the position sensor 472 for the tracking system 480comprising an absolute positioning system comprises a magnetic rotaryabsolute positioning system. The position sensor 472 may be implementedas an AS5055EQFT single-chip magnetic rotary position sensor availablefrom Austria Microsystems, AG. The position sensor 472 is interfacedwith the microcontroller 461 to provide an absolute positioning system.The position sensor 472 is a low-voltage and low-power component andincludes four Hall-effect elements in an area of the position sensor 472that is located above a magnet. A high-resolution ADC and a smart powermanagement controller are also provided on the chip. A coordinaterotation digital computer (CORDIC) processor, also known as thedigit-by-digit method and Volder's algorithm, is provided to implement asimple and efficient algorithm to calculate hyperbolic and trigonometricfunctions that require only addition, subtraction, bitshift, and tablelookup operations. The angle position, alarm bits, and magnetic fieldinformation are transmitted over a standard serial communicationinterface, such as a serial peripheral interface (SPI) interface, to themicrocontroller 461. The position sensor 472 provides 12 or 14 bits ofresolution. The position sensor 472 may be an AS5055 chip provided in asmall QFN 16-pin 4×4×0.85 mm package.

The tracking system 480 comprising an absolute positioning system maycomprise and/or be programmed to implement a feedback controller, suchas a PID, state feedback, and adaptive controller. A power sourceconverts the signal from the feedback controller into a physical inputto the system: in this case the voltage. Other examples include a PWM ofthe voltage, current, and force. Other sensor(s) may be provided tomeasure physical parameters of the physical system in addition to theposition measured by the position sensor 472. In some aspects, the othersensor(s) can include sensor arrangements such as those described inU.S. Pat. No. 9,345,481, entitled STAPLE CARTRIDGE TISSUE THICKNESSSENSOR SYSTEM, which issued on May 24, 2016, which is hereinincorporated by reference in its entirety; U.S. Patent ApplicationPublication No. 2014/0263552, entitled STAPLE CARTRIDGE TISSUE THICKNESSSENSOR SYSTEM, which published on Sep. 18, 2014, which is hereinincorporated by reference in its entirety; and U.S. patent applicationSer. No. 15/628,175, entitled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTORVELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT, filed Jun. 20,2017, which is herein incorporated by reference in its entirety. In adigital signal processing system, an absolute positioning system iscoupled to a digital data acquisition system where the output of theabsolute positioning system will have a finite resolution and samplingfrequency. The absolute positioning system may comprise acompare-and-combine circuit to combine a computed response with ameasured response using algorithms, such as a weighted average and atheoretical control loop, that drive the computed response towards themeasured response. The computed response of the physical system takesinto account properties like mass, inertial, viscous friction,inductance resistance, etc., to predict what the states and outputs ofthe physical system will be by knowing the input.

The absolute positioning system provides an absolute position of thedisplacement member upon power-up of the instrument, without retractingor advancing the displacement member to a reset (zero or home) positionas may be required with conventional rotary encoders that merely countthe number of steps forwards or backwards that the motor 482 has takento infer the position of a device actuator, drive bar, knife, or thelike.

A sensor 474, such as, for example, a strain gauge or a micro-straingauge, is configured to measure one or more parameters of the endeffector, such as, for example, the amplitude of the strain exerted onthe anvil during a clamping operation, which can be indicative of theclosure forces applied to the anvil. The measured strain is converted toa digital signal and provided to the processor 462. Alternatively, or inaddition to the sensor 474, a sensor 476, such as, for example, a loadsensor, can measure the closure force applied by the closure drivesystem to the anvil. The sensor 476, such as, for example, a loadsensor, can measure the firing force applied to an I-beam in a firingstroke of the surgical instrument or tool. The I-beam is configured toengage a wedge sled, which is configured to upwardly cam staple driversto force out staples into deforming contact with an anvil. The I-beamalso includes a sharpened cutting edge that can be used to sever tissueas the I-beam is advanced distally by the firing bar. Alternatively, acurrent sensor 478 can be employed to measure the current drawn by themotor 482. The force required to advance the firing member cancorrespond to the current drawn by the motor 482, for example. Themeasured force is converted to a digital signal and provided to theprocessor 462.

In one form, the strain gauge sensor 474 can be used to measure theforce applied to the tissue by the end effector. A strain gauge can becoupled to the end effector to measure the force on the tissue beingtreated by the end effector. A system for measuring forces applied tothe tissue grasped by the end effector comprises a strain gauge sensor474, such as, for example, a micro-strain gauge, that is configured tomeasure one or more parameters of the end effector, for example. In oneaspect, the strain gauge sensor 474 can measure the amplitude ormagnitude of the strain exerted on a jaw member of an end effectorduring a clamping operation, which can be indicative of the tissuecompression. The measured strain is converted to a digital signal andprovided to a processor 462 of the microcontroller 461. A load sensor476 can measure the force used to operate the knife element, forexample, to cut the tissue captured between the anvil and the staplecartridge. A magnetic field sensor can be employed to measure thethickness of the captured tissue. The measurement of the magnetic fieldsensor also may be converted to a digital signal and provided to theprocessor 462.

The measurements of the tissue compression, the tissue thickness, and/orthe force required to close the end effector on the tissue, asrespectively measured by the sensors 474, 476, can be used by themicrocontroller 461 to characterize the selected position of the firingmember and/or the corresponding value of the speed of the firing member.In one instance, a memory 468 may store a technique, an equation, and/ora lookup table which can be employed by the microcontroller 461 in theassessment.

The control system 470 of the surgical instrument or tool also maycomprise wired or wireless communication circuits to communicate withthe modular communication hub as shown in FIGS. 8-11 .

FIG. 13 illustrates a control circuit 500 configured to control aspectsof the surgical instrument or tool according to one aspect of thisdisclosure. The control circuit 500 can be configured to implementvarious processes described herein. The control circuit 500 may comprisea microcontroller comprising one or more processors 502 (e.g.,microprocessor, microcontroller) coupled to at least one memory circuit504. The memory circuit 504 stores machine-executable instructions that,when executed by the processor 502, cause the processor 502 to executemachine instructions to implement various processes described herein.The processor 502 may be any one of a number of single-core or multicoreprocessors known in the art. The memory circuit 504 may comprisevolatile and non-volatile storage media. The processor 502 may includean instruction processing unit 506 and an arithmetic unit 508. Theinstruction processing unit may be configured to receive instructionsfrom the memory circuit 504 of this disclosure.

FIG. 14 illustrates a combinational logic circuit 510 configured tocontrol aspects of the surgical instrument or tool according to oneaspect of this disclosure. The combinational logic circuit 510 can beconfigured to implement various processes described herein. Thecombinational logic circuit 510 may comprise a finite state machinecomprising a combinational logic 512 configured to receive dataassociated with the surgical instrument or tool at an input 514, processthe data by the combinational logic 512, and provide an output 516.

FIG. 15 illustrates a sequential logic circuit 520 configured to controlaspects of the surgical instrument or tool according to one aspect ofthis disclosure. The sequential logic circuit 520 or the combinationallogic 522 can be configured to implement various processes describedherein. The sequential logic circuit 520 may comprise a finite statemachine. The sequential logic circuit 520 may comprise a combinationallogic 522, at least one memory circuit 524, and a clock 529, forexample. The at least one memory circuit 524 can store a current stateof the finite state machine. In certain instances, the sequential logiccircuit 520 may be synchronous or asynchronous. The combinational logic522 is configured to receive data associated with the surgicalinstrument or tool from an input 526, process the data by thecombinational logic 522, and provide an output 528. In other aspects,the circuit may comprise a combination of a processor (e.g., processor502, FIG. 13 ) and a finite state machine to implement various processesherein. In other aspects, the finite state machine may comprise acombination of a combinational logic circuit (e.g., combinational logiccircuit 510, FIG. 14 ) and the sequential logic circuit 520.

FIG. 16 illustrates a surgical instrument or tool comprising a pluralityof motors which can be activated to perform various functions. Incertain instances, a first motor can be activated to perform a firstfunction, a second motor can be activated to perform a second function,a third motor can be activated to perform a third function, a fourthmotor can be activated to perform a fourth function, and so on. Incertain instances, the plurality of motors of robotic surgicalinstrument 600 can be individually activated to cause firing, closure,and/or articulation motions in the end effector. The firing, closure,and/or articulation motions can be transmitted to the end effectorthrough a shaft assembly, for example.

In certain instances, the surgical instrument system or tool may includea firing motor 602. The firing motor 602 may be operably coupled to afiring motor drive assembly 604 which can be configured to transmitfiring motions, generated by the motor 602 to the end effector, inparticular to displace the I-beam element. In certain instances, thefiring motions generated by the motor 602 may cause the staples to bedeployed from the staple cartridge into tissue captured by the endeffector and/or the cutting edge of the I-beam element to be advanced tocut the captured tissue, for example. The I-beam element may beretracted by reversing the direction of the motor 602.

In certain instances, the surgical instrument or tool may include aclosure motor 603. The closure motor 603 may be operably coupled to aclosure motor drive assembly 605 which can be configured to transmitclosure motions, generated by the motor 603 to the end effector, inparticular to displace a closure tube to close the anvil and compresstissue between the anvil and the staple cartridge. The closure motionsmay cause the end effector to transition from an open configuration toan approximated configuration to capture tissue, for example. The endeffector may be transitioned to an open position by reversing thedirection of the motor 603.

In certain instances, the surgical instrument or tool may include one ormore articulation motors 606 a, 606 b, for example. The motors 606 a,606 b may be operably coupled to respective articulation motor driveassemblies 608 a, 608 b, which can be configured to transmitarticulation motions generated by the motors 606 a, 606 b to the endeffector. In certain instances, the articulation motions may cause theend effector to articulate relative to the shaft, for example.

As described above, the surgical instrument or tool may include aplurality of motors which may be configured to perform variousindependent functions. In certain instances, the plurality of motors ofthe surgical instrument or tool can be individually or separatelyactivated to perform one or more functions while the other motors remaininactive. For example, the articulation motors 606 a, 606 b can beactivated to cause the end effector to be articulated while the firingmotor 602 remains inactive. Alternatively, the firing motor 602 can beactivated to fire the plurality of staples, and/or to advance thecutting edge, while the articulation motor 606 remains inactive.Furthermore, the closure motor 603 may be activated simultaneously withthe firing motor 602 to cause the closure tube and the I-beam element toadvance distally as described in more detail hereinbelow.

In certain instances, the surgical instrument or tool may include acommon control module 610 which can be employed with a plurality ofmotors of the surgical instrument or tool. In certain instances, thecommon control module 610 may accommodate one of the plurality of motorsat a time. For example, the common control module 610 can be couplableto and separable from the plurality of motors of the robotic surgicalinstrument individually. In certain instances, a plurality of the motorsof the surgical instrument or tool may share one or more common controlmodules such as the common control module 610. In certain instances, aplurality of motors of the surgical instrument or tool can beindividually and selectively engaged with the common control module 610.In certain instances, the common control module 610 can be selectivelyswitched from interfacing with one of a plurality of motors of thesurgical instrument or tool to interfacing with another one of theplurality of motors of the surgical instrument or tool.

In at least one example, the common control module 610 can beselectively switched between operable engagement with the articulationmotors 606 a, 606 b and operable engagement with either the firing motor602 or the closure motor 603. In at least one example, as illustrated inFIG. 16 , a switch 614 can be moved or transitioned between a pluralityof positions and/or states. In a first position 616, the switch 614 mayelectrically couple the common control module 610 to the firing motor602; in a second position 617, the switch 614 may electrically couplethe common control module 610 to the closure motor 603; in a thirdposition 618 a, the switch 614 may electrically couple the commoncontrol module 610 to the first articulation motor 606 a; and in afourth position 618 b, the switch 614 may electrically couple the commoncontrol module 610 to the second articulation motor 606 b, for example.In certain instances, separate common control modules 610 can beelectrically coupled to the firing motor 602, the closure motor 603, andthe articulations motor 606 a, 606 b at the same time. In certaininstances, the switch 614 may be a mechanical switch, anelectromechanical switch, a solid-state switch, or any suitableswitching mechanism.

Each of the motors 602, 603, 606 a, 606 b may comprise a torque sensorto measure the output torque on the shaft of the motor. The force on anend effector may be sensed in any conventional manner, such as by forcesensors on the outer sides of the jaws or by a torque sensor for themotor actuating the jaws.

In various instances, as illustrated in FIG. 16 , the common controlmodule 610 may comprise a motor driver 626 which may comprise one ormore H-Bridge FETs. The motor driver 626 may modulate the powertransmitted from a power source 628 to a motor coupled to the commoncontrol module 610 based on input from a microcontroller 620 (the“controller”), for example. In certain instances, the microcontroller620 can be employed to determine the current drawn by the motor, forexample, while the motor is coupled to the common control module 610, asdescribed above.

In certain instances, the microcontroller 620 may include amicroprocessor 622 (the “processor”) and one or more non-transitorycomputer-readable mediums or memory units 624 (the “memory”). In certaininstances, the memory 624 may store various program instructions, whichwhen executed may cause the processor 622 to perform a plurality offunctions and/or calculations described herein. In certain instances,one or more of the memory units 624 may be coupled to the processor 622,for example.

In certain instances, the power source 628 can be employed to supplypower to the microcontroller 620, for example. In certain instances, thepower source 628 may comprise a battery (or “battery pack” or “powerpack”), such as a lithium-ion battery, for example. In certaininstances, the battery pack may be configured to be releasably mountedto a handle for supplying power to the surgical instrument 600. A numberof battery cells connected in series may be used as the power source628. In certain instances, the power source 628 may be replaceableand/or rechargeable, for example.

In various instances, the processor 622 may control the motor driver 626to control the position, direction of rotation, and/or velocity of amotor that is coupled to the common control module 610. In certaininstances, the processor 622 can signal the motor driver 626 to stopand/or disable a motor that is coupled to the common control module 610.It should be understood that the term “processor” as used hereinincludes any suitable microprocessor, microcontroller, or other basiccomputing device that incorporates the functions of a computer's centralprocessing unit (CPU) on an integrated circuit or, at most, a fewintegrated circuits. The processor is a multipurpose, programmabledevice that accepts digital data as input, processes it according toinstructions stored in its memory, and provides results as output. It isan example of sequential digital logic, as it has internal memory.Processors operate on numbers and symbols represented in the binarynumeral system.

In one instance, the processor 622 may be any single-core or multicoreprocessor such as those known under the trade name ARM Cortex by TexasInstruments. In certain instances, the microcontroller 620 may be an LM4F230H5QR, available from Texas Instruments, for example. In at leastone example, the Texas Instruments LM4F230H5QR is an ARM Cortex-M4FProcessor Core comprising an on-chip memory of 256 KB single-cycle flashmemory, or other non-volatile memory, up to 40 MHz, a prefetch buffer toimprove performance above 40 MHz, a 32 KB single-cycle SRAM, an internalROM loaded with StellarisWare® software, a 2 KB EEPROM, one or more PWMmodules, one or more QEI analogs, one or more 12-bit ADCs with 12 analoginput channels, among other features that are readily available for theproduct datasheet. Other microcontrollers may be readily substituted foruse with the module 4410. Accordingly, the present disclosure should notbe limited in this context.

In certain instances, the memory 624 may include program instructionsfor controlling each of the motors of the surgical instrument 600 thatare couplable to the common control module 610. For example, the memory624 may include program instructions for controlling the firing motor602, the closure motor 603, and the articulation motors 606 a, 606 b.Such program instructions may cause the processor 622 to control thefiring, closure, and articulation functions in accordance with inputsfrom algorithms or control programs of the surgical instrument or tool.

In certain instances, one or more mechanisms and/or sensors such as, forexample, sensors 630 can be employed to alert the processor 622 to theprogram instructions that should be used in a particular setting. Forexample, the sensors 630 may alert the processor 622 to use the programinstructions associated with firing, closing, and articulating the endeffector. In certain instances, the sensors 630 may comprise positionsensors which can be employed to sense the position of the switch 614,for example. Accordingly, the processor 622 may use the programinstructions associated with firing the I-beam of the end effector upondetecting, through the sensors 630 for example, that the switch 614 isin the first position 616; the processor 622 may use the programinstructions associated with closing the anvil upon detecting, throughthe sensors 630 for example, that the switch 614 is in the secondposition 617; and the processor 622 may use the program instructionsassociated with articulating the end effector upon detecting, throughthe sensors 630 for example, that the switch 614 is in the third orfourth position 618 a, 618 b.

FIG. 17 is a schematic diagram of a robotic surgical instrument 700configured to operate a surgical tool described herein according to oneaspect of this disclosure. The robotic surgical instrument 700 may beprogrammed or configured to control distal/proximal translation of adisplacement member, distal/proximal displacement of a closure tube,shaft rotation, and articulation, either with single or multiplearticulation drive links. In one aspect, the surgical instrument 700 maybe programmed or configured to individually control a firing member, aclosure member, a shaft member, and/or one or more articulation members.The surgical instrument 700 comprises a control circuit 710 configuredto control motor-driven firing members, closure members, shaft members,and/or one or more articulation members.

In one aspect, the robotic surgical instrument 700 comprises a controlcircuit 710 configured to control an anvil 716 and an I-beam 714(including a sharp cutting edge) portion of an end effector 702, aremovable staple cartridge 718, a shaft 740, and one or morearticulation members 742 a, 742 b via a plurality of motors 704 a-704 e.A position sensor 734 may be configured to provide position feedback ofthe I-beam 714 to the control circuit 710. Other sensors 738 may beconfigured to provide feedback to the control circuit 710. Atimer/counter 731 provides timing and counting information to thecontrol circuit 710. An energy source 712 may be provided to operate themotors 704 a-704 e, and a current sensor 736 provides motor currentfeedback to the control circuit 710. The motors 704 a-704 e can beoperated individually by the control circuit 710 in an open-loop orclosed-loop feedback control.

In one aspect, the control circuit 710 may comprise one or moremicrocontrollers, microprocessors, or other suitable processors forexecuting instructions that cause the processor or processors to performone or more tasks. In one aspect, a timer/counter 731 provides an outputsignal, such as the elapsed time or a digital count, to the controlcircuit 710 to correlate the position of the I-beam 714 as determined bythe position sensor 734 with the output of the timer/counter 731 suchthat the control circuit 710 can determine the position of the I-beam714 at a specific time (t) relative to a starting position or the time(t) when the I-beam 714 is at a specific position relative to a startingposition. The timer/counter 731 may be configured to measure elapsedtime, count external events, or time external events.

In one aspect, the control circuit 710 may be programmed to controlfunctions of the end effector 702 based on one or more tissueconditions. The control circuit 710 may be programmed to sense tissueconditions, such as thickness, either directly or indirectly, asdescribed herein. The control circuit 710 may be programmed to select afiring control program or closure control program based on tissueconditions. A firing control program may describe the distal motion ofthe displacement member. Different firing control programs may beselected to better treat different tissue conditions. For example, whenthicker tissue is present, the control circuit 710 may be programmed totranslate the displacement member at a lower velocity and/or with lowerpower. When thinner tissue is present, the control circuit 710 may beprogrammed to translate the displacement member at a higher velocityand/or with higher power. A closure control program may control theclosure force applied to the tissue by the anvil 716. Other controlprograms control the rotation of the shaft 740 and the articulationmembers 742 a, 742 b.

In one aspect, the control circuit 710 may generate motor set pointsignals. The motor set point signals may be provided to various motorcontrollers 708 a-708 e. The motor controllers 708 a-708 e may compriseone or more circuits configured to provide motor drive signals to themotors 704 a-704 e to drive the motors 704 a-704 e as described herein.In some examples, the motors 704 a-704 e may be brushed DC electricmotors. For example, the velocity of the motors 704 a-704 e may beproportional to the respective motor drive signals. In some examples,the motors 704 a-704 e may be brushless DC electric motors, and therespective motor drive signals may comprise a PWM signal provided to oneor more stator windings of the motors 704 a-704 e. Also, in someexamples, the motor controllers 708 a-708 e may be omitted and thecontrol circuit 710 may generate the motor drive signals directly.

In one aspect, the control circuit 710 may initially operate each of themotors 704 a-704 e in an open-loop configuration for a first open-loopportion of a stroke of the displacement member. Based on the response ofthe robotic surgical instrument 700 during the open-loop portion of thestroke, the control circuit 710 may select a firing control program in aclosed-loop configuration. The response of the instrument may include atranslation distance of the displacement member during the open-loopportion, a time elapsed during the open-loop portion, the energyprovided to one of the motors 704 a-704 e during the open-loop portion,a sum of pulse widths of a motor drive signal, etc. After the open-loopportion, the control circuit 710 may implement the selected firingcontrol program for a second portion of the displacement member stroke.For example, during a closed-loop portion of the stroke, the controlcircuit 710 may modulate one of the motors 704 a-704 e based ontranslation data describing a position of the displacement member in aclosed-loop manner to translate the displacement member at a constantvelocity.

In one aspect, the motors 704 a-704 e may receive power from an energysource 712. The energy source 712 may be a DC power supply driven by amain alternating current power source, a battery, a super capacitor, orany other suitable energy source. The motors 704 a-704 e may bemechanically coupled to individual movable mechanical elements such asthe I-beam 714, anvil 716, shaft 740, articulation 742 a, andarticulation 742 b via respective transmissions 706 a-706 e. Thetransmissions 706 a-706 e may include one or more gears or other linkagecomponents to couple the motors 704 a-704 e to movable mechanicalelements. A position sensor 734 may sense a position of the I-beam 714.The position sensor 734 may be or include any type of sensor that iscapable of generating position data that indicate a position of theI-beam 714. In some examples, the position sensor 734 may include anencoder configured to provide a series of pulses to the control circuit710 as the I-beam 714 translates distally and proximally. The controlcircuit 710 may track the pulses to determine the position of the I-beam714. Other suitable position sensors may be used, including, forexample, a proximity sensor. Other types of position sensors may provideother signals indicating motion of the I-beam 714. Also, in someexamples, the position sensor 734 may be omitted. Where any of themotors 704 a-704 e is a stepper motor, the control circuit 710 may trackthe position of the I-beam 714 by aggregating the number and directionof steps that the motor 704 has been instructed to execute. The positionsensor 734 may be located in the end effector 702 or at any otherportion of the instrument. The outputs of each of the motors 704 a-704 einclude a torque sensor 744 a-744 e to sense force and have an encoderto sense rotation of the drive shaft.

In one aspect, the control circuit 710 is configured to drive a firingmember such as the I-beam 714 portion of the end effector 702. Thecontrol circuit 710 provides a motor set point to a motor control 708 a,which provides a drive signal to the motor 704 a. The output shaft ofthe motor 704 a is coupled to a torque sensor 744 a. The torque sensor744 a is coupled to a transmission 706 a which is coupled to the I-beam714. The transmission 706 a comprises movable mechanical elements suchas rotating elements and a firing member to control the movement of theI-beam 714 distally and proximally along a longitudinal axis of the endeffector 702. In one aspect, the motor 704 a may be coupled to the knifegear assembly, which includes a knife gear reduction set that includes afirst knife drive gear and a second knife drive gear. A torque sensor744 a provides a firing force feedback signal to the control circuit710. The firing force signal represents the force required to fire ordisplace the I-beam 714. A position sensor 734 may be configured toprovide the position of the I-beam 714 along the firing stroke or theposition of the firing member as a feedback signal to the controlcircuit 710. The end effector 702 may include additional sensors 738configured to provide feedback signals to the control circuit 710. Whenready to use, the control circuit 710 may provide a firing signal to themotor control 708 a. In response to the firing signal, the motor 704 amay drive the firing member distally along the longitudinal axis of theend effector 702 from a proximal stroke start position to a stroke endposition distal to the stroke start position. As the firing membertranslates distally, an I-beam 714, with a cutting element positioned ata distal end, advances distally to cut tissue located between the staplecartridge 718 and the anvil 716.

In one aspect, the control circuit 710 is configured to drive a closuremember such as the anvil 716 portion of the end effector 702. Thecontrol circuit 710 provides a motor set point to a motor control 708 b,which provides a drive signal to the motor 704 b. The output shaft ofthe motor 704 b is coupled to a torque sensor 744 b. The torque sensor744 b is coupled to a transmission 706 b which is coupled to the anvil716. The transmission 706 b comprises movable mechanical elements suchas rotating elements and a closure member to control the movement of theanvil 716 from the open and closed positions. In one aspect, the motor704 b is coupled to a closure gear assembly, which includes a closurereduction gear set that is supported in meshing engagement with theclosure spur gear. The torque sensor 744 b provides a closure forcefeedback signal to the control circuit 710. The closure force feedbacksignal represents the closure force applied to the anvil 716. Theposition sensor 734 may be configured to provide the position of theclosure member as a feedback signal to the control circuit 710.Additional sensors 738 in the end effector 702 may provide the closureforce feedback signal to the control circuit 710. The pivotable anvil716 is positioned opposite the staple cartridge 718. When ready to use,the control circuit 710 may provide a closure signal to the motorcontrol 708 b. In response to the closure signal, the motor 704 badvances a closure member to grasp tissue between the anvil 716 and thestaple cartridge 718.

In one aspect, the control circuit 710 is configured to rotate a shaftmember such as the shaft 740 to rotate the end effector 702. The controlcircuit 710 provides a motor set point to a motor control 708 c, whichprovides a drive signal to the motor 704 c. The output shaft of themotor 704 c is coupled to a torque sensor 744 c. The torque sensor 744 cis coupled to a transmission 706 c which is coupled to the shaft 740.The transmission 706 c comprises movable mechanical elements such asrotating elements to control the rotation of the shaft 740 clockwise orcounterclockwise up to and over 360°. In one aspect, the motor 704 c iscoupled to the rotational transmission assembly, which includes a tubegear segment that is formed on (or attached to) the proximal end of theproximal closure tube for operable engagement by a rotational gearassembly that is operably supported on the tool mounting plate. Thetorque sensor 744 c provides a rotation force feedback signal to thecontrol circuit 710. The rotation force feedback signal represents therotation force applied to the shaft 740. The position sensor 734 may beconfigured to provide the position of the closure member as a feedbacksignal to the control circuit 710. Additional sensors 738 such as ashaft encoder may provide the rotational position of the shaft 740 tothe control circuit 710.

In one aspect, the control circuit 710 is configured to articulate theend effector 702. The control circuit 710 provides a motor set point toa motor control 708 d, which provides a drive signal to the motor 704 d.The output shaft of the motor 704 d is coupled to a torque sensor 744 d.The torque sensor 744 d is coupled to a transmission 706 d which iscoupled to an articulation member 742 a. The transmission 706 dcomprises movable mechanical elements such as articulation elements tocontrol the articulation of the end effector 702 ±65°. In one aspect,the motor 704 d is coupled to an articulation nut, which is rotatablyjournaled on the proximal end portion of the distal spine portion and isrotatably driven thereon by an articulation gear assembly. The torquesensor 744 d provides an articulation force feedback signal to thecontrol circuit 710. The articulation force feedback signal representsthe articulation force applied to the end effector 702. Sensors 738,such as an articulation encoder, may provide the articulation positionof the end effector 702 to the control circuit 710.

In another aspect, the articulation function of the robotic surgicalsystem 700 may comprise two articulation members, or links, 742 a, 742b. These articulation members 742 a, 742 b are driven by separate diskson the robot interface (the rack) which are driven by the two motors 708d, 708 e. When the separate firing motor 704 a is provided, each ofarticulation links 742 a, 742 b can be antagonistically driven withrespect to the other link in order to provide a resistive holding motionand a load to the head when it is not moving and to provide anarticulation motion as the head is articulated. The articulation members742 a, 742 b attach to the head at a fixed radius as the head isrotated. Accordingly, the mechanical advantage of the push-and-pull linkchanges as the head is rotated. This change in the mechanical advantagemay be more pronounced with other articulation link drive systems.

In one aspect, the one or more motors 704 a-704 e may comprise a brushedDC motor with a gearbox and mechanical links to a firing member, closuremember, or articulation member. Another example includes electric motors704 a-704 e that operate the movable mechanical elements such as thedisplacement member, articulation links, closure tube, and shaft. Anoutside influence is an unmeasured, unpredictable influence of thingslike tissue, surrounding bodies, and friction on the physical system.Such outside influence can be referred to as drag, which acts inopposition to one of electric motors 704 a-704 e. The outside influence,such as drag, may cause the operation of the physical system to deviatefrom a desired operation of the physical system.

In one aspect, the position sensor 734 may be implemented as an absolutepositioning system. In one aspect, the position sensor 734 may comprisea magnetic rotary absolute positioning system implemented as anAS5055EQFT single-chip magnetic rotary position sensor available fromAustria Microsystems, AG. The position sensor 734 may interface with thecontrol circuit 710 to provide an absolute positioning system. Theposition may include multiple Hall-effect elements located above amagnet and coupled to a CORDIC processor, also known as thedigit-by-digit method and Volder's algorithm, that is provided toimplement a simple and efficient algorithm to calculate hyperbolic andtrigonometric functions that require only addition, subtraction,bitshift, and table lookup operations.

In one aspect, the control circuit 710 may be in communication with oneor more sensors 738. The sensors 738 may be positioned on the endeffector 702 and adapted to operate with the robotic surgical instrument700 to measure the various derived parameters such as the gap distanceversus time, tissue compression versus time, and anvil strain versustime. The sensors 738 may comprise a magnetic sensor, a magnetic fieldsensor, a strain gauge, a load cell, a pressure sensor, a force sensor,a torque sensor, an inductive sensor such as an eddy current sensor, aresistive sensor, a capacitive sensor, an optical sensor, and/or anyother suitable sensor for measuring one or more parameters of the endeffector 702. The sensors 738 may include one or more sensors. Thesensors 738 may be located on the staple cartridge 718 deck to determinetissue location using segmented electrodes. The torque sensors 744 a-744e may be configured to sense force such as firing force, closure force,and/or articulation force, among others. Accordingly, the controlcircuit 710 can sense (1) the closure load experienced by the distalclosure tube and its position, (2) the firing member at the rack and itsposition, (3) what portion of the staple cartridge 718 has tissue on it,and (4) the load and position on both articulation rods.

In one aspect, the one or more sensors 738 may comprise a strain gauge,such as a micro-strain gauge, configured to measure the magnitude of thestrain in the anvil 716 during a clamped condition. The strain gaugeprovides an electrical signal whose amplitude varies with the magnitudeof the strain. The sensors 738 may comprise a pressure sensor configuredto detect a pressure generated by the presence of compressed tissuebetween the anvil 716 and the staple cartridge 718. The sensors 738 maybe configured to detect impedance of a tissue section located betweenthe anvil 716 and the staple cartridge 718 that is indicative of thethickness and/or fullness of tissue located therebetween.

In one aspect, the sensors 738 may be implemented as one or more limitswitches, electromechanical devices, solid-state switches, Hall-effectdevices, magneto-resistive (MR) devices, giant magneto-resistive (GMR)devices, magnetometers, among others. In other implementations, thesensors 738 may be implemented as solid-state switches that operateunder the influence of light, such as optical sensors, IR sensors,ultraviolet sensors, among others. Still, the switches may besolid-state devices such as transistors (e.g., FET, junction FET,MOSFET, bipolar, and the like). In other implementations, the sensors738 may include electrical conductorless switches, ultrasonic switches,accelerometers, and inertial sensors, among others.

In one aspect, the sensors 738 may be configured to measure forcesexerted on the anvil 716 by the closure drive system. For example, oneor more sensors 738 can be at an interaction point between the closuretube and the anvil 716 to detect the closure forces applied by theclosure tube to the anvil 716. The forces exerted on the anvil 716 canbe representative of the tissue compression experienced by the tissuesection captured between the anvil 716 and the staple cartridge 718. Theone or more sensors 738 can be positioned at various interaction pointsalong the closure drive system to detect the closure forces applied tothe anvil 716 by the closure drive system. The one or more sensors 738may be sampled in real time during a clamping operation by the processorof the control circuit 710. The control circuit 710 receives real-timesample measurements to provide and analyze time-based information andassess, in real time, closure forces applied to the anvil 716.

In one aspect, a current sensor 736 can be employed to measure thecurrent drawn by each of the motors 704 a-704 e. The force required toadvance any of the movable mechanical elements such as the I-beam 714corresponds to the current drawn by one of the motors 704 a-704 e. Theforce is converted to a digital signal and provided to the controlcircuit 710. The control circuit 710 can be configured to simulate theresponse of the actual system of the instrument in the software of thecontroller. A displacement member can be actuated to move an I-beam 714in the end effector 702 at or near a target velocity. The roboticsurgical instrument 700 can include a feedback controller, which can beone of any feedback controllers, including, but not limited to a PID, astate feedback, a linear-quadratic (LQR), and/or an adaptive controller,for example. The robotic surgical instrument 700 can include a powersource to convert the signal from the feedback controller into aphysical input such as case voltage, PWM voltage, frequency modulatedvoltage, current, torque, and/or force, for example. Additional detailsare disclosed in U.S. patent application Ser. No. 15/636,829, entitledCLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT,filed Jun. 29, 2017, which is herein incorporated by reference in itsentirety.

FIG. 18 illustrates a block diagram of a surgical instrument 750programmed to control the distal translation of a displacement memberaccording to one aspect of this disclosure. In one aspect, the surgicalinstrument 750 is programmed to control the distal translation of adisplacement member such as the I-beam 764. The surgical instrument 750comprises an end effector 752 that may comprise an anvil 766, an I-beam764 (including a sharp cutting edge), and a removable staple cartridge768.

The position, movement, displacement, and/or translation of a lineardisplacement member, such as the I-beam 764, can be measured by anabsolute positioning system, sensor arrangement, and position sensor784. Because the I-beam 764 is coupled to a longitudinally movable drivemember, the position of the I-beam 764 can be determined by measuringthe position of the longitudinally movable drive member employing theposition sensor 784. Accordingly, in the following description, theposition, displacement, and/or translation of the I-beam 764 can beachieved by the position sensor 784 as described herein. A controlcircuit 760 may be programmed to control the translation of thedisplacement member, such as the I-beam 764. The control circuit 760, insome examples, may comprise one or more microcontrollers,microprocessors, or other suitable processors for executing instructionsthat cause the processor or processors to control the displacementmember, e.g., the I-beam 764, in the manner described. In one aspect, atimer/counter 781 provides an output signal, such as the elapsed time ora digital count, to the control circuit 760 to correlate the position ofthe I-beam 764 as determined by the position sensor 784 with the outputof the timer/counter 781 such that the control circuit 760 can determinethe position of the I-beam 764 at a specific time (t) relative to astarting position. The timer/counter 781 may be configured to measureelapsed time, count external events, or time external events.

The control circuit 760 may generate a motor set point signal 772. Themotor set point signal 772 may be provided to a motor controller 758.The motor controller 758 may comprise one or more circuits configured toprovide a motor drive signal 774 to the motor 754 to drive the motor 754as described herein. In some examples, the motor 754 may be a brushed DCelectric motor. For example, the velocity of the motor 754 may beproportional to the motor drive signal 774. In some examples, the motor754 may be a brushless DC electric motor and the motor drive signal 774may comprise a PWM signal provided to one or more stator windings of themotor 754. Also, in some examples, the motor controller 758 may beomitted, and the control circuit 760 may generate the motor drive signal774 directly.

The motor 754 may receive power from an energy source 762. The energysource 762 may be or include a battery, a super capacitor, or any othersuitable energy source. The motor 754 may be mechanically coupled to theI-beam 764 via a transmission 756. The transmission 756 may include oneor more gears or other linkage components to couple the motor 754 to theI-beam 764. A position sensor 784 may sense a position of the I-beam764. The position sensor 784 may be or include any type of sensor thatis capable of generating position data that indicate a position of theI-beam 764. In some examples, the position sensor 784 may include anencoder configured to provide a series of pulses to the control circuit760 as the I-beam 764 translates distally and proximally. The controlcircuit 760 may track the pulses to determine the position of the I-beam764. Other suitable position sensors may be used, including, forexample, a proximity sensor. Other types of position sensors may provideother signals indicating motion of the I-beam 764. Also, in someexamples, the position sensor 784 may be omitted. Where the motor 754 isa stepper motor, the control circuit 760 may track the position of theI-beam 764 by aggregating the number and direction of steps that themotor 754 has been instructed to execute. The position sensor 784 may belocated in the end effector 752 or at any other portion of theinstrument.

The control circuit 760 may be in communication with one or more sensors788. The sensors 788 may be positioned on the end effector 752 andadapted to operate with the surgical instrument 750 to measure thevarious derived parameters such as gap distance versus time, tissuecompression versus time, and anvil strain versus time. The sensors 788may comprise a magnetic sensor, a magnetic field sensor, a strain gauge,a pressure sensor, a force sensor, an inductive sensor such as an eddycurrent sensor, a resistive sensor, a capacitive sensor, an opticalsensor, and/or any other suitable sensor for measuring one or moreparameters of the end effector 752. The sensors 788 may include one ormore sensors.

The one or more sensors 788 may comprise a strain gauge, such as amicro-strain gauge, configured to measure the magnitude of the strain inthe anvil 766 during a clamped condition. The strain gauge provides anelectrical signal whose amplitude varies with the magnitude of thestrain. The sensors 788 may comprise a pressure sensor configured todetect a pressure generated by the presence of compressed tissue betweenthe anvil 766 and the staple cartridge 768. The sensors 788 may beconfigured to detect impedance of a tissue section located between theanvil 766 and the staple cartridge 768 that is indicative of thethickness and/or fullness of tissue located therebetween.

The sensors 788 may be is configured to measure forces exerted on theanvil 766 by a closure drive system. For example, one or more sensors788 can be at an interaction point between a closure tube and the anvil766 to detect the closure forces applied by a closure tube to the anvil766. The forces exerted on the anvil 766 can be representative of thetissue compression experienced by the tissue section captured betweenthe anvil 766 and the staple cartridge 768. The one or more sensors 788can be positioned at various interaction points along the closure drivesystem to detect the closure forces applied to the anvil 766 by theclosure drive system. The one or more sensors 788 may be sampled in realtime during a clamping operation by a processor of the control circuit760. The control circuit 760 receives real-time sample measurements toprovide and analyze time-based information and assess, in real time,closure forces applied to the anvil 766.

A current sensor 786 can be employed to measure the current drawn by themotor 754. The force required to advance the I-beam 764 corresponds tothe current drawn by the motor 754. The force is converted to a digitalsignal and provided to the control circuit 760.

The control circuit 760 can be configured to simulate the response ofthe actual system of the instrument in the software of the controller. Adisplacement member can be actuated to move an I-beam 764 in the endeffector 752 at or near a target velocity. The surgical instrument 750can include a feedback controller, which can be one of any feedbackcontrollers, including, but not limited to a PID, a state feedback, LQR,and/or an adaptive controller, for example. The surgical instrument 750can include a power source to convert the signal from the feedbackcontroller into a physical input such as case voltage, PWM voltage,frequency modulated voltage, current, torque, and/or force, for example.

The actual drive system of the surgical instrument 750 is configured todrive the displacement member, cutting member, or I-beam 764, by abrushed DC motor with gearbox and mechanical links to an articulationand/or knife system. Another example is the electric motor 754 thatoperates the displacement member and the articulation driver, forexample, of an interchangeable shaft assembly. An outside influence isan unmeasured, unpredictable influence of things like tissue,surrounding bodies and friction on the physical system. Such outsideinfluence can be referred to as drag which acts in opposition to theelectric motor 754. The outside influence, such as drag, may cause theoperation of the physical system to deviate from a desired operation ofthe physical system.

Various example aspects are directed to a surgical instrument 750comprising an end effector 752 with motor-driven surgical stapling andcutting implements. For example, a motor 754 may drive a displacementmember distally and proximally along a longitudinal axis of the endeffector 752. The end effector 752 may comprise a pivotable anvil 766and, when configured for use, a staple cartridge 768 positioned oppositethe anvil 766. A clinician may grasp tissue between the anvil 766 andthe staple cartridge 768, as described herein. When ready to use theinstrument 750, the clinician may provide a firing signal, for exampleby depressing a trigger of the instrument 750. In response to the firingsignal, the motor 754 may drive the displacement member distally alongthe longitudinal axis of the end effector 752 from a proximal strokebegin position to a stroke end position distal of the stroke beginposition. As the displacement member translates distally, an I-beam 764with a cutting element positioned at a distal end, may cut the tissuebetween the staple cartridge 768 and the anvil 766.

In various examples, the surgical instrument 750 may comprise a controlcircuit 760 programmed to control the distal translation of thedisplacement member, such as the I-beam 764, for example, based on oneor more tissue conditions. The control circuit 760 may be programmed tosense tissue conditions, such as thickness, either directly orindirectly, as described herein. The control circuit 760 may beprogrammed to select a firing control program based on tissueconditions. A firing control program may describe the distal motion ofthe displacement member. Different firing control programs may beselected to better treat different tissue conditions. For example, whenthicker tissue is present, the control circuit 760 may be programmed totranslate the displacement member at a lower velocity and/or with lowerpower. When thinner tissue is present, the control circuit 760 may beprogrammed to translate the displacement member at a higher velocityand/or with higher power.

In some examples, the control circuit 760 may initially operate themotor 754 in an open loop configuration for a first open loop portion ofa stroke of the displacement member. Based on a response of theinstrument 750 during the open loop portion of the stroke, the controlcircuit 760 may select a firing control program. The response of theinstrument may include, a translation distance of the displacementmember during the open loop portion, a time elapsed during the open loopportion, energy provided to the motor 754 during the open loop portion,a sum of pulse widths of a motor drive signal, etc. After the open loopportion, the control circuit 760 may implement the selected firingcontrol program for a second portion of the displacement member stroke.For example, during the closed loop portion of the stroke, the controlcircuit 760 may modulate the motor 754 based on translation datadescribing a position of the displacement member in a closed loop mannerto translate the displacement member at a constant velocity. Additionaldetails are disclosed in U.S. patent application Ser. No. 15/720,852,entitled SYSTEM AND METHODS FOR CONTROLLING A DISPLAY OF A SURGICALINSTRUMENT, filed Sep. 29, 2017, which is herein incorporated byreference in its entirety.

FIG. 19 is a schematic diagram of a surgical instrument 790 configuredto control various functions according to one aspect of this disclosure.In one aspect, the surgical instrument 790 is programmed to controldistal translation of a displacement member such as the I-beam 764. Thesurgical instrument 790 comprises an end effector 792 that may comprisean anvil 766, an I-beam 764, and a removable staple cartridge 768 whichmay be interchanged with an RF cartridge 796 (shown in dashed line).

In one aspect, sensors 788 may be implemented as a limit switch,electromechanical device, solid-state switches, Hall-effect devices, MRdevices, GMR devices, magnetometers, among others. In otherimplementations, the sensors 638 may be solid-state switches thatoperate under the influence of light, such as optical sensors, IRsensors, ultraviolet sensors, among others. Still, the switches may besolid-state devices such as transistors (e.g., FET, junction FET,MOSFET, bipolar, and the like). In other implementations, the sensors788 may include electrical conductorless switches, ultrasonic switches,accelerometers, and inertial sensors, among others.

In one aspect, the position sensor 784 may be implemented as an absolutepositioning system comprising a magnetic rotary absolute positioningsystem implemented as an AS5055EQFT single-chip magnetic rotary positionsensor available from Austria Microsystems, AG. The position sensor 784may interface with the control circuit 760 to provide an absolutepositioning system. The position may include multiple Hall-effectelements located above a magnet and coupled to a CORDIC processor, alsoknown as the digit-by-digit method and Volder's algorithm, that isprovided to implement a simple and efficient algorithm to calculatehyperbolic and trigonometric functions that require only addition,subtraction, bitshift, and table lookup operations.

In one aspect, the I-beam 764 may be implemented as a knife membercomprising a knife body that operably supports a tissue cutting bladethereon and may further include anvil engagement tabs or features andchannel engagement features or a foot. In one aspect, the staplecartridge 768 may be implemented as a standard (mechanical) surgicalfastener cartridge. In one aspect, the RF cartridge 796 may beimplemented as an RF cartridge. These and other sensors arrangements aredescribed in commonly-owned U.S. patent application Ser. No. 15/628,175,entitled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICALSTAPLING AND CUTTING INSTRUMENT, filed Jun. 20, 2017, which is hereinincorporated by reference in its entirety.

The position, movement, displacement, and/or translation of a lineardisplacement member, such as the I-beam 764, can be measured by anabsolute positioning system, sensor arrangement, and position sensorrepresented as position sensor 784. Because the I-beam 764 is coupled tothe longitudinally movable drive member, the position of the I-beam 764can be determined by measuring the position of the longitudinallymovable drive member employing the position sensor 784. Accordingly, inthe following description, the position, displacement, and/ortranslation of the I-beam 764 can be achieved by the position sensor 784as described herein. A control circuit 760 may be programmed to controlthe translation of the displacement member, such as the I-beam 764, asdescribed herein. The control circuit 760, in some examples, maycomprise one or more microcontrollers, microprocessors, or othersuitable processors for executing instructions that cause the processoror processors to control the displacement member, e.g., the I-beam 764,in the manner described. In one aspect, a timer/counter 781 provides anoutput signal, such as the elapsed time or a digital count, to thecontrol circuit 760 to correlate the position of the I-beam 764 asdetermined by the position sensor 784 with the output of thetimer/counter 781 such that the control circuit 760 can determine theposition of the I-beam 764 at a specific time (t) relative to a startingposition. The timer/counter 781 may be configured to measure elapsedtime, count external events, or time external events.

The control circuit 760 may generate a motor set point signal 772. Themotor set point signal 772 may be provided to a motor controller 758.The motor controller 758 may comprise one or more circuits configured toprovide a motor drive signal 774 to the motor 754 to drive the motor 754as described herein. In some examples, the motor 754 may be a brushed DCelectric motor. For example, the velocity of the motor 754 may beproportional to the motor drive signal 774. In some examples, the motor754 may be a brushless DC electric motor and the motor drive signal 774may comprise a PWM signal provided to one or more stator windings of themotor 754. Also, in some examples, the motor controller 758 may beomitted, and the control circuit 760 may generate the motor drive signal774 directly.

The motor 754 may receive power from an energy source 762. The energysource 762 may be or include a battery, a super capacitor, or any othersuitable energy source. The motor 754 may be mechanically coupled to theI-beam 764 via a transmission 756. The transmission 756 may include oneor more gears or other linkage components to couple the motor 754 to theI-beam 764. A position sensor 784 may sense a position of the I-beam764. The position sensor 784 may be or include any type of sensor thatis capable of generating position data that indicate a position of theI-beam 764. In some examples, the position sensor 784 may include anencoder configured to provide a series of pulses to the control circuit760 as the I-beam 764 translates distally and proximally. The controlcircuit 760 may track the pulses to determine the position of the I-beam764. Other suitable position sensors may be used, including, forexample, a proximity sensor. Other types of position sensors may provideother signals indicating motion of the I-beam 764. Also, in someexamples, the position sensor 784 may be omitted. Where the motor 754 isa stepper motor, the control circuit 760 may track the position of theI-beam 764 by aggregating the number and direction of steps that themotor has been instructed to execute. The position sensor 784 may belocated in the end effector 792 or at any other portion of theinstrument.

The control circuit 760 may be in communication with one or more sensors788. The sensors 788 may be positioned on the end effector 792 andadapted to operate with the surgical instrument 790 to measure thevarious derived parameters such as gap distance versus time, tissuecompression versus time, and anvil strain versus time. The sensors 788may comprise a magnetic sensor, a magnetic field sensor, a strain gauge,a pressure sensor, a force sensor, an inductive sensor such as an eddycurrent sensor, a resistive sensor, a capacitive sensor, an opticalsensor, and/or any other suitable sensor for measuring one or moreparameters of the end effector 792. The sensors 788 may include one ormore sensors.

The one or more sensors 788 may comprise a strain gauge, such as amicro-strain gauge, configured to measure the magnitude of the strain inthe anvil 766 during a clamped condition. The strain gauge provides anelectrical signal whose amplitude varies with the magnitude of thestrain. The sensors 788 may comprise a pressure sensor configured todetect a pressure generated by the presence of compressed tissue betweenthe anvil 766 and the staple cartridge 768. The sensors 788 may beconfigured to detect impedance of a tissue section located between theanvil 766 and the staple cartridge 768 that is indicative of thethickness and/or fullness of tissue located therebetween.

The sensors 788 may be is configured to measure forces exerted on theanvil 766 by the closure drive system. For example, one or more sensors788 can be at an interaction point between a closure tube and the anvil766 to detect the closure forces applied by a closure tube to the anvil766. The forces exerted on the anvil 766 can be representative of thetissue compression experienced by the tissue section captured betweenthe anvil 766 and the staple cartridge 768. The one or more sensors 788can be positioned at various interaction points along the closure drivesystem to detect the closure forces applied to the anvil 766 by theclosure drive system. The one or more sensors 788 may be sampled in realtime during a clamping operation by a processor portion of the controlcircuit 760. The control circuit 760 receives real-time samplemeasurements to provide and analyze time-based information and assess,in real time, closure forces applied to the anvil 766.

A current sensor 786 can be employed to measure the current drawn by themotor 754. The force required to advance the I-beam 764 corresponds tothe current drawn by the motor 754. The force is converted to a digitalsignal and provided to the control circuit 760.

An RF energy source 794 is coupled to the end effector 792 and isapplied to the RF cartridge 796 when the RF cartridge 796 is loaded inthe end effector 792 in place of the staple cartridge 768. The controlcircuit 760 controls the delivery of the RF energy to the RF cartridge796.

Additional details are disclosed in U.S. patent application Ser. No.15/636,096, entitled SURGICAL SYSTEM COUPLABLE WITH STAPLE CARTRIDGE ANDRADIO FREQUENCY CARTRIDGE, AND METHOD OF USING SAME, filed Jun. 28,2017, which is herein incorporated by reference in its entirety.

Generator Hardware

FIG. 20 is a simplified block diagram of a generator 800 configured toprovide inductorless tuning, among other benefits. Additional details ofthe generator 800 are described in U.S. Pat. No. 9,060,775, entitledSURGICAL GENERATOR FOR ULTRASONIC AND ELECTROSURGICAL DEVICES, whichissued on Jun. 23, 2015, which is herein incorporated by reference inits entirety. The generator 800 may comprise a patient isolated stage802 in communication with a non-isolated stage 804 via a powertransformer 806. A secondary winding 808 of the power transformer 806 iscontained in the isolated stage 802 and may comprise a tappedconfiguration (e.g., a center-tapped or a non-center-tappedconfiguration) to define drive signal outputs 810 a, 810 b, 810 c fordelivering drive signals to different surgical instruments, such as, forexample, an ultrasonic surgical instrument, an RF electrosurgicalinstrument, and a multifunction surgical instrument which includesultrasonic and RF energy modes that can be delivered alone orsimultaneously. In particular, drive signal outputs 810 a, 810 c mayoutput an ultrasonic drive signal (e.g., a 420V root-mean-square (RMS)drive signal) to an ultrasonic surgical instrument, and drive signaloutputs 810 b, 810 c may output an RF electrosurgical drive signal(e.g., a 100V RMS drive signal) to an RF electrosurgical instrument,with the drive signal output 810 b corresponding to the center tap ofthe power transformer 806.

In certain forms, the ultrasonic and electrosurgical drive signals maybe provided simultaneously to distinct surgical instruments and/or to asingle surgical instrument, such as the multifunction surgicalinstrument, having the capability to deliver both ultrasonic andelectrosurgical energy to tissue. It will be appreciated that theelectrosurgical signal, provided either to a dedicated electrosurgicalinstrument and/or to a combined multifunction ultrasonic/electrosurgicalinstrument may be either a therapeutic or sub-therapeutic level signalwhere the sub-therapeutic signal can be used, for example, to monitortissue or instrument conditions and provide feedback to the generator.For example, the ultrasonic and RF signals can be delivered separatelyor simultaneously from a generator with a single output port in order toprovide the desired output signal to the surgical instrument, as will bediscussed in more detail below. Accordingly, the generator can combinethe ultrasonic and electrosurgical RF energies and deliver the combinedenergies to the multifunction ultrasonic/electrosurgical instrument.Bipolar electrodes can be placed on one or both jaws of the endeffector. One jaw may be driven by ultrasonic energy in addition toelectrosurgical RF energy, working simultaneously. The ultrasonic energymay be employed to dissect tissue, while the electrosurgical RF energymay be employed for vessel sealing.

The non-isolated stage 804 may comprise a power amplifier 812 having anoutput connected to a primary winding 814 of the power transformer 806.In certain forms, the power amplifier 812 may comprise a push-pullamplifier. For example, the non-isolated stage 804 may further comprisea logic device 816 for supplying a digital output to a digital-to-analogconverter (DAC) circuit 818, which in turn supplies a correspondinganalog signal to an input of the power amplifier 812. In certain forms,the logic device 816 may comprise a programmable gate array (PGA), aFPGA, programmable logic device (PLD), among other logic circuits, forexample. The logic device 816, by virtue of controlling the input of thepower amplifier 812 via the DAC circuit 818, may therefore control anyof a number of parameters (e.g., frequency, waveform shape, waveformamplitude) of drive signals appearing at the drive signal outputs 810 a,810 b, 810 c. In certain forms and as discussed below, the logic device816, in conjunction with a processor (e.g., a DSP discussed below), mayimplement a number of DSP-based and/or other control algorithms tocontrol parameters of the drive signals output by the generator 800.

Power may be supplied to a power rail of the power amplifier 812 by aswitch-mode regulator 820, e.g., a power converter. In certain forms,the switch-mode regulator 820 may comprise an adjustable buck regulator,for example. The non-isolated stage 804 may further comprise a firstprocessor 822, which in one form may comprise a DSP processor such as anAnalog Devices ADSP-21469 SHARC DSP, available from Analog Devices,Norwood, Mass., for example, although in various forms any suitableprocessor may be employed. In certain forms the DSP processor 822 maycontrol the operation of the switch-mode regulator 820 responsive tovoltage feedback data received from the power amplifier 812 by the DSPprocessor 822 via an ADC circuit 824. In one form, for example, the DSPprocessor 822 may receive as input, via the ADC circuit 824, thewaveform envelope of a signal (e.g., an RF signal) being amplified bythe power amplifier 812. The DSP processor 822 may then control theswitch-mode regulator 820 (e.g., via a PWM output) such that the railvoltage supplied to the power amplifier 812 tracks the waveform envelopeof the amplified signal. By dynamically modulating the rail voltage ofthe power amplifier 812 based on the waveform envelope, the efficiencyof the power amplifier 812 may be significantly improved relative to afixed rail voltage amplifier schemes.

In certain forms, the logic device 816, in conjunction with the DSPprocessor 822, may implement a digital synthesis circuit such as adirect digital synthesizer control scheme to control the waveform shape,frequency, and/or amplitude of drive signals output by the generator800. In one form, for example, the logic device 816 may implement a DDScontrol algorithm by recalling waveform samples stored in a dynamicallyupdated lookup table (LUT), such as a RAM LUT, which may be embedded inan FPGA. This control algorithm is particularly useful for ultrasonicapplications in which an ultrasonic transducer, such as an ultrasonictransducer, may be driven by a clean sinusoidal current at its resonantfrequency. Because other frequencies may excite parasitic resonances,minimizing or reducing the total distortion of the motional branchcurrent may correspondingly minimize or reduce undesirable resonanceeffects. Because the waveform shape of a drive signal output by thegenerator 800 is impacted by various sources of distortion present inthe output drive circuit (e.g., the power transformer 806, the poweramplifier 812), voltage and current feedback data based on the drivesignal may be input into an algorithm, such as an error controlalgorithm implemented by the DSP processor 822, which compensates fordistortion by suitably pre-distorting or modifying the waveform samplesstored in the LUT on a dynamic, ongoing basis (e.g., in real time). Inone form, the amount or degree of pre-distortion applied to the LUTsamples may be based on the error between a computed motional branchcurrent and a desired current waveform shape, with the error beingdetermined on a sample-by-sample basis. In this way, the pre-distortedLUT samples, when processed through the drive circuit, may result in amotional branch drive signal having the desired waveform shape (e.g.,sinusoidal) for optimally driving the ultrasonic transducer. In suchforms, the LUT waveform samples will therefore not represent the desiredwaveform shape of the drive signal, but rather the waveform shape thatis required to ultimately produce the desired waveform shape of themotional branch drive signal when distortion effects are taken intoaccount.

The non-isolated stage 804 may further comprise a first ADC circuit 826and a second ADC circuit 828 coupled to the output of the powertransformer 806 via respective isolation transformers 830, 832 forrespectively sampling the voltage and current of drive signals output bythe generator 800. In certain forms, the ADC circuits 826, 828 may beconfigured to sample at high speeds (e.g., 80 mega samples per second(MSPS)) to enable oversampling of the drive signals. In one form, forexample, the sampling speed of the ADC circuits 826, 828 may enableapproximately 200× (depending on frequency) oversampling of the drivesignals. In certain forms, the sampling operations of the ADC circuit826, 828 may be performed by a single ADC circuit receiving inputvoltage and current signals via a two-way multiplexer. The use ofhigh-speed sampling in forms of the generator 800 may enable, amongother things, calculation of the complex current flowing through themotional branch (which may be used in certain forms to implementDDS-based waveform shape control described above), accurate digitalfiltering of the sampled signals, and calculation of real powerconsumption with a high degree of precision. Voltage and currentfeedback data output by the ADC circuits 826, 828 may be received andprocessed (e.g., first-in-first-out (FIFO) buffer, multiplexer) by thelogic device 816 and stored in data memory for subsequent retrieval by,for example, the DSP processor 822. As noted above, voltage and currentfeedback data may be used as input to an algorithm for pre-distorting ormodifying LUT waveform samples on a dynamic and ongoing basis. Incertain forms, this may require each stored voltage and current feedbackdata pair to be indexed based on, or otherwise associated with, acorresponding LUT sample that was output by the logic device 816 whenthe voltage and current feedback data pair was acquired. Synchronizationof the LUT samples and the voltage and current feedback data in thismanner contributes to the correct timing and stability of thepre-distortion algorithm.

In certain forms, the voltage and current feedback data may be used tocontrol the frequency and/or amplitude (e.g., current amplitude) of thedrive signals. In one form, for example, voltage and current feedbackdata may be used to determine impedance phase. The frequency of thedrive signal may then be controlled to minimize or reduce the differencebetween the determined impedance phase and an impedance phase setpoint(e.g., 0°), thereby minimizing or reducing the effects of harmonicdistortion and correspondingly enhancing impedance phase measurementaccuracy. The determination of phase impedance and a frequency controlsignal may be implemented in the DSP processor 822, for example, withthe frequency control signal being supplied as input to a DDS controlalgorithm implemented by the logic device 816.

In another form, for example, the current feedback data may be monitoredin order to maintain the current amplitude of the drive signal at acurrent amplitude setpoint. The current amplitude setpoint may bespecified directly or determined indirectly based on specified voltageamplitude and power setpoints. In certain forms, control of the currentamplitude may be implemented by control algorithm, such as, for example,a proportional-integral-derivative (PID) control algorithm, in the DSPprocessor 822. Variables controlled by the control algorithm to suitablycontrol the current amplitude of the drive signal may include, forexample, the scaling of the LUT waveform samples stored in the logicdevice 816 and/or the full-scale output voltage of the DAC circuit 818(which supplies the input to the power amplifier 812) via a DAC circuit834.

The non-isolated stage 804 may further comprise a second processor 836for providing, among other things user interface (UI) functionality. Inone form, the UI processor 836 may comprise an Atmel AT91SAM9263processor having an ARM 926EJ-S core, available from Atmel Corporation,San Jose, Calif., for example. Examples of UI functionality supported bythe UI processor 836 may include audible and visual user feedback,communication with peripheral devices (e.g., via a USB interface),communication with a foot switch, communication with an input device(e.g., a touch screen display) and communication with an output device(e.g., a speaker). The UI processor 836 may communicate with the DSPprocessor 822 and the logic device 816 (e.g., via SPI buses). Althoughthe UI processor 836 may primarily support UI functionality, it may alsocoordinate with the DSP processor 822 to implement hazard mitigation incertain forms. For example, the UI processor 836 may be programmed tomonitor various aspects of user input and/or other inputs (e.g., touchscreen inputs, foot switch inputs, temperature sensor inputs) and maydisable the drive output of the generator 800 when an erroneouscondition is detected.

In certain forms, both the DSP processor 822 and the UI processor 836,for example, may determine and monitor the operating state of thegenerator 800. For the DSP processor 822, the operating state of thegenerator 800 may dictate, for example, which control and/or diagnosticprocesses are implemented by the DSP processor 822. For the UI processor836, the operating state of the generator 800 may dictate, for example,which elements of a UI (e.g., display screens, sounds) are presented toa user. The respective DSP and UI processors 822, 836 may independentlymaintain the current operating state of the generator 800 and recognizeand evaluate possible transitions out of the current operating state.The DSP processor 822 may function as the master in this relationshipand determine when transitions between operating states are to occur.The UI processor 836 may be aware of valid transitions between operatingstates and may confirm if a particular transition is appropriate. Forexample, when the DSP processor 822 instructs the UI processor 836 totransition to a specific state, the UI processor 836 may verify thatrequested transition is valid. In the event that a requested transitionbetween states is determined to be invalid by the UI processor 836, theUI processor 836 may cause the generator 800 to enter a failure mode.

The non-isolated stage 804 may further comprise a controller 838 formonitoring input devices (e.g., a capacitive touch sensor used forturning the generator 800 on and off, a capacitive touch screen). Incertain forms, the controller 838 may comprise at least one processorand/or other controller device in communication with the UI processor836. In one form, for example, the controller 838 may comprise aprocessor (e.g., a Meg168 8-bit controller available from Atmel)configured to monitor user input provided via one or more capacitivetouch sensors. In one form, the controller 838 may comprise a touchscreen controller (e.g., a QT5480 touch screen controller available fromAtmel) to control and manage the acquisition of touch data from acapacitive touch screen.

In certain forms, when the generator 800 is in a “power off” state, thecontroller 838 may continue to receive operating power (e.g., via a linefrom a power supply of the generator 800, such as the power supply 854discussed below). In this way, the controller 838 may continue tomonitor an input device (e.g., a capacitive touch sensor located on afront panel of the generator 800) for turning the generator 800 on andoff. When the generator 800 is in the power off state, the controller838 may wake the power supply (e.g., enable operation of one or moreDC/DC voltage converters 856 of the power supply 854) if activation ofthe “on/off” input device by a user is detected. The controller 838 maytherefore initiate a sequence for transitioning the generator 800 to a“power on” state. Conversely, the controller 838 may initiate a sequencefor transitioning the generator 800 to the power off state if activationof the “on/off” input device is detected when the generator 800 is inthe power on state. In certain forms, for example, the controller 838may report activation of the “on/off” input device to the UI processor836, which in turn implements the necessary process sequence fortransitioning the generator 800 to the power off state. In such forms,the controller 838 may have no independent ability for causing theremoval of power from the generator 800 after its power on state hasbeen established.

In certain forms, the controller 838 may cause the generator 800 toprovide audible or other sensory feedback for alerting the user that apower on or power off sequence has been initiated. Such an alert may beprovided at the beginning of a power on or power off sequence and priorto the commencement of other processes associated with the sequence.

In certain forms, the isolated stage 802 may comprise an instrumentinterface circuit 840 to, for example, provide a communication interfacebetween a control circuit of a surgical instrument (e.g., a controlcircuit comprising handpiece switches) and components of thenon-isolated stage 804, such as, for example, the logic device 816, theDSP processor 822, and/or the UI processor 836. The instrument interfacecircuit 840 may exchange information with components of the non-isolatedstage 804 via a communication link that maintains a suitable degree ofelectrical isolation between the isolated and non-isolated stages 802,804, such as, for example, an IR-based communication link. Power may besupplied to the instrument interface circuit 840 using, for example, alow-dropout voltage regulator powered by an isolation transformer drivenfrom the non-isolated stage 804.

In one form, the instrument interface circuit 840 may comprise a logiccircuit 842 (e.g., logic circuit, programmable logic circuit, PGA, FPGA,PLD) in communication with a signal conditioning circuit 844. The signalconditioning circuit 844 may be configured to receive a periodic signalfrom the logic circuit 842 (e.g., a 2 kHz square wave) to generate abipolar interrogation signal having an identical frequency. Theinterrogation signal may be generated, for example, using a bipolarcurrent source fed by a differential amplifier. The interrogation signalmay be communicated to a surgical instrument control circuit (e.g., byusing a conductive pair in a cable that connects the generator 800 tothe surgical instrument) and monitored to determine a state orconfiguration of the control circuit. The control circuit may comprise anumber of switches, resistors, and/or diodes to modify one or morecharacteristics (e.g., amplitude, rectification) of the interrogationsignal such that a state or configuration of the control circuit isuniquely discernable based on the one or more characteristics. In oneform, for example, the signal conditioning circuit 844 may comprise anADC circuit for generating samples of a voltage signal appearing acrossinputs of the control circuit resulting from passage of interrogationsignal therethrough. The logic circuit 842 (or a component of thenon-isolated stage 804) may then determine the state or configuration ofthe control circuit based on the ADC circuit samples.

In one form, the instrument interface circuit 840 may comprise a firstdata circuit interface 846 to enable information exchange between thelogic circuit 842 (or other element of the instrument interface circuit840) and a first data circuit disposed in or otherwise associated with asurgical instrument. In certain forms, for example, a first data circuitmay be disposed in a cable integrally attached to a surgical instrumenthandpiece or in an adaptor for interfacing a specific surgicalinstrument type or model with the generator 800. The first data circuitmay be implemented in any suitable manner and may communicate with thegenerator according to any suitable protocol, including, for example, asdescribed herein with respect to the first data circuit. In certainforms, the first data circuit may comprise a non-volatile storagedevice, such as an EEPROM device. In certain forms, the first datacircuit interface 846 may be implemented separately from the logiccircuit 842 and comprise suitable circuitry (e.g., discrete logicdevices, a processor) to enable communication between the logic circuit842 and the first data circuit. In other forms, the first data circuitinterface 846 may be integral with the logic circuit 842.

In certain forms, the first data circuit may store informationpertaining to the particular surgical instrument with which it isassociated. Such information may include, for example, a model number, aserial number, a number of operations in which the surgical instrumenthas been used, and/or any other type of information. This informationmay be read by the instrument interface circuit 840 (e.g., by the logiccircuit 842), transferred to a component of the non-isolated stage 804(e.g., to logic device 816, DSP processor 822, and/or UI processor 836)for presentation to a user via an output device and/or for controlling afunction or operation of the generator 800. Additionally, any type ofinformation may be communicated to the first data circuit for storagetherein via the first data circuit interface 846 (e.g., using the logiccircuit 842). Such information may comprise, for example, an updatednumber of operations in which the surgical instrument has been usedand/or dates and/or times of its usage.

As discussed previously, a surgical instrument may be detachable from ahandpiece (e.g., the multifunction surgical instrument may be detachablefrom the handpiece) to promote instrument interchangeability and/ordisposability. In such cases, conventional generators may be limited intheir ability to recognize particular instrument configurations beingused and to optimize control and diagnostic processes accordingly. Theaddition of readable data circuits to surgical instruments to addressthis issue is problematic from a compatibility standpoint, however. Forexample, designing a surgical instrument to remain backwardly compatiblewith generators that lack the requisite data reading functionality maybe impractical due to, for example, differing signal schemes, designcomplexity, and cost. Forms of instruments discussed herein addressthese concerns by using data circuits that may be implemented inexisting surgical instruments economically and with minimal designchanges to preserve compatibility of the surgical instruments withcurrent generator platforms.

Additionally, forms of the generator 800 may enable communication withinstrument-based data circuits. For example, the generator 800 may beconfigured to communicate with a second data circuit contained in aninstrument (e.g., the multifunction surgical instrument). In some forms,the second data circuit may be implemented in a many similar to that ofthe first data circuit described herein. The instrument interfacecircuit 840 may comprise a second data circuit interface 848 to enablethis communication. In one form, the second data circuit interface 848may comprise a tri-state digital interface, although other interfacesmay also be used. In certain forms, the second data circuit maygenerally be any circuit for transmitting and/or receiving data. In oneform, for example, the second data circuit may store informationpertaining to the particular surgical instrument with which it isassociated. Such information may include, for example, a model number, aserial number, a number of operations in which the surgical instrumenthas been used, and/or any other type of information.

In some forms, the second data circuit may store information about theelectrical and/or ultrasonic properties of an associated ultrasonictransducer, end effector, or ultrasonic drive system. For example, thefirst data circuit may indicate a burn-in frequency slope, as describedherein. Additionally or alternatively, any type of information may becommunicated to second data circuit for storage therein via the seconddata circuit interface 848 (e.g., using the logic circuit 842). Suchinformation may comprise, for example, an updated number of operationsin which the instrument has been used and/or dates and/or times of itsusage. In certain forms, the second data circuit may transmit dataacquired by one or more sensors (e.g., an instrument-based temperaturesensor). In certain forms, the second data circuit may receive data fromthe generator 800 and provide an indication to a user (e.g., a lightemitting diode indication or other visible indication) based on thereceived data.

In certain forms, the second data circuit and the second data circuitinterface 848 may be configured such that communication between thelogic circuit 842 and the second data circuit can be effected withoutthe need to provide additional conductors for this purpose (e.g.,dedicated conductors of a cable connecting a handpiece to the generator800). In one form, for example, information may be communicated to andfrom the second data circuit using a one-wire bus communication schemeimplemented on existing cabling, such as one of the conductors usedtransmit interrogation signals from the signal conditioning circuit 844to a control circuit in a handpiece. In this way, design changes ormodifications to the surgical instrument that might otherwise benecessary are minimized or reduced. Moreover, because different types ofcommunications implemented over a common physical channel can befrequency-band separated, the presence of a second data circuit may be“invisible” to generators that do not have the requisite data readingfunctionality, thus enabling backward compatibility of the surgicalinstrument.

In certain forms, the isolated stage 802 may comprise at least oneblocking capacitor 850-1 connected to the drive signal output 810 b toprevent passage of DC current to a patient. A single blocking capacitormay be required to comply with medical regulations or standards, forexample. While failure in single-capacitor designs is relativelyuncommon, such failure may nonetheless have negative consequences. Inone form, a second blocking capacitor 850-2 may be provided in serieswith the blocking capacitor 850-1, with current leakage from a pointbetween the blocking capacitors 850-1, 850-2 being monitored by, forexample, an ADC circuit 852 for sampling a voltage induced by leakagecurrent. The samples may be received by the logic circuit 842, forexample. Based changes in the leakage current (as indicated by thevoltage samples), the generator 800 may determine when at least one ofthe blocking capacitors 850-1, 850-2 has failed, thus providing abenefit over single-capacitor designs having a single point of failure.

In certain forms, the non-isolated stage 804 may comprise a power supply854 for delivering DC power at a suitable voltage and current. The powersupply may comprise, for example, a 400 W power supply for delivering a48 VDC system voltage. The power supply 854 may further comprise one ormore DC/DC voltage converters 856 for receiving the output of the powersupply to generate DC outputs at the voltages and currents required bythe various components of the generator 800. As discussed above inconnection with the controller 838, one or more of the DC/DC voltageconverters 856 may receive an input from the controller 838 whenactivation of the “on/off” input device by a user is detected by thecontroller 838 to enable operation of, or wake, the DC/DC voltageconverters 856.

FIG. 21 illustrates an example of a generator 900, which is one form ofthe generator 800 (FIG. 20 ). The generator 900 is configured to delivermultiple energy modalities to a surgical instrument. The generator 900provides RF and ultrasonic signals for delivering energy to a surgicalinstrument either independently or simultaneously. The RF and ultrasonicsignals may be provided alone or in combination and may be providedsimultaneously. As noted above, at least one generator output candeliver multiple energy modalities (e.g., ultrasonic, bipolar ormonopolar RF, irreversible and/or reversible electroporation, and/ormicrowave energy, among others) through a single port, and these signalscan be delivered separately or simultaneously to the end effector totreat tissue. The generator 900 comprises a processor 902 coupled to awaveform generator 904. The processor 902 and waveform generator 904 areconfigured to generate a variety of signal waveforms based oninformation stored in a memory coupled to the processor 902, not shownfor clarity of disclosure. The digital information associated with awaveform is provided to the waveform generator 904 which includes one ormore DAC circuits to convert the digital input into an analog output.The analog output is fed to an amplifier 1106 for signal conditioningand amplification. The conditioned and amplified output of the amplifier906 is coupled to a power transformer 908. The signals are coupledacross the power transformer 908 to the secondary side, which is in thepatient isolation side. A first signal of a first energy modality isprovided to the surgical instrument between the terminals labeledENERGY1 and RETURN. A second signal of a second energy modality iscoupled across a capacitor 910 and is provided to the surgicalinstrument between the terminals labeled ENERGY2 and RETURN. It will beappreciated that more than two energy modalities may be output and thusthe subscript “n” may be used to designate that up to n ENERGYnterminals may be provided, where n is a positive integer greater than 1.It also will be appreciated that up to “n” return paths RETURNn may beprovided without departing from the scope of the present disclosure.

A first voltage sensing circuit 912 is coupled across the terminalslabeled ENERGY1 and the RETURN path to measure the output voltagetherebetween. A second voltage sensing circuit 924 is coupled across theterminals labeled ENERGY2 and the RETURN path to measure the outputvoltage therebetween. A current sensing circuit 914 is disposed inseries with the RETURN leg of the secondary side of the powertransformer 908 as shown to measure the output current for either energymodality. If different return paths are provided for each energymodality, then a separate current sensing circuit should be provided ineach return leg. The outputs of the first and second voltage sensingcircuits 912, 924 are provided to respective isolation transformers 916,922 and the output of the current sensing circuit 914 is provided toanother isolation transformer 918. The outputs of the isolationtransformers 916, 928, 922 in the on the primary side of the powertransformer 908 (non-patient isolated side) are provided to a one ormore ADC circuit 926. The digitized output of the ADC circuit 926 isprovided to the processor 902 for further processing and computation.The output voltages and output current feedback information can beemployed to adjust the output voltage and current provided to thesurgical instrument and to compute output impedance, among otherparameters. Input/output communications between the processor 902 andpatient isolated circuits is provided through an interface circuit 920.Sensors also may be in electrical communication with the processor 902by way of the interface circuit 920.

In one aspect, the impedance may be determined by the processor 902 bydividing the output of either the first voltage sensing circuit 912coupled across the terminals labeled ENERGY1/RETURN or the secondvoltage sensing circuit 924 coupled across the terminals labeledENERGY2/RETURN by the output of the current sensing circuit 914 disposedin series with the RETURN leg of the secondary side of the powertransformer 908. The outputs of the first and second voltage sensingcircuits 912, 924 are provided to separate isolations transformers 916,922 and the output of the current sensing circuit 914 is provided toanother isolation transformer 916. The digitized voltage and currentsensing measurements from the ADC circuit 926 are provided the processor902 for computing impedance. As an example, the first energy modalityENERGY1 may be ultrasonic energy and the second energy modality ENERGY2may be RF energy. Nevertheless, in addition to ultrasonic and bipolar ormonopolar RF energy modalities, other energy modalities includeirreversible and/or reversible electroporation and/or microwave energy,among others. Also, although the example illustrated in FIG. 21 shows asingle return path RETURN may be provided for two or more energymodalities, in other aspects, multiple return paths RETURNn may beprovided for each energy modality ENERGYn. Thus, as described herein,the ultrasonic transducer impedance may be measured by dividing theoutput of the first voltage sensing circuit 912 by the current sensingcircuit 914 and the tissue impedance may be measured by dividing theoutput of the second voltage sensing circuit 924 by the current sensingcircuit 914.

As shown in FIG. 21 , the generator 900 comprising at least one outputport can include a power transformer 908 with a single output and withmultiple taps to provide power in the form of one or more energymodalities, such as ultrasonic, bipolar or monopolar RF, irreversibleand/or reversible electroporation, and/or microwave energy, amongothers, for example, to the end effector depending on the type oftreatment of tissue being performed. For example, the generator 900 candeliver energy with higher voltage and lower current to drive anultrasonic transducer, with lower voltage and higher current to drive RFelectrodes for sealing tissue, or with a coagulation waveform for spotcoagulation using either monopolar or bipolar RF electrosurgicalelectrodes. The output waveform from the generator 900 can be steered,switched, or filtered to provide the frequency to the end effector ofthe surgical instrument. The connection of an ultrasonic transducer tothe generator 900 output would be preferably located between the outputlabeled ENERGY1 and RETURN as shown in FIG. 21 . In one example, aconnection of RF bipolar electrodes to the generator 900 output would bepreferably located between the output labeled ENERGY2 and RETURN. In thecase of monopolar output, the preferred connections would be activeelectrode (e.g., pencil or other probe) to the ENERGY2 output and asuitable return pad connected to the RETURN output.

Additional details are disclosed in U.S. Patent Application PublicationNo. 2017/0086914, entitled TECHNIQUES FOR OPERATING GENERATOR FORDIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICALINSTRUMENTS, which published on Mar. 30, 2017, which is hereinincorporated by reference in its entirety.

As used throughout this description, the term “wireless” and itsderivatives may be used to describe circuits, devices, systems, methods,techniques, communications channels, etc., that may communicate datathrough the use of modulated electromagnetic radiation through anon-solid medium. The term does not imply that the associated devices donot contain any wires, although in some aspects they might not. Thecommunication module may implement any of a number of wireless or wiredcommunication standards or protocols, including but not limited to Wi-Fi(IEEE 802.11 family), WiMAX (IEEE 802.16 family), IEEE 802.20, long termevolution (LTE), Ev-DO, HSPA+, HSDPA+, HSUPA+, EDGE, GSM, GPRS, CDMA,TDMA, DECT, Bluetooth, Ethernet derivatives thereof, as well as anyother wireless and wired protocols that are designated as 3G, 4G, 5G,and beyond. The computing module may include a plurality ofcommunication modules. For instance, a first communication module may bededicated to shorter range wireless communications such as Wi-Fi andBluetooth and a second communication module may be dedicated to longerrange wireless communications such as GPS, EDGE, GPRS, CDMA, WiMAX, LTE,Ev-DO, and others.

As used herein a processor or processing unit is an electronic circuitwhich performs operations on some external data source, usually memoryor some other data stream. The term is used herein to refer to thecentral processor (central processing unit) in a system or computersystems (especially systems on a chip (SoCs)) that combine a number ofspecialized “processors.”

As used herein, a system on a chip or system on chip (SoC or SOC) is anintegrated circuit (also known as an “IC” or “chip”) that integrates allcomponents of a computer or other electronic systems. It may containdigital, analog, mixed-signal, and often radio-frequency functions—allon a single substrate. A SoC integrates a microcontroller (ormicroprocessor) with advanced peripherals like graphics processing unit(GPU), Wi-Fi module, or coprocessor. A SoC may or may not containbuilt-in memory.

As used herein, a microcontroller or controller is a system thatintegrates a microprocessor with peripheral circuits and memory. Amicrocontroller (or MCU for microcontroller unit) may be implemented asa small computer on a single integrated circuit. It may be similar to aSoC; an SoC may include a microcontroller as one of its components. Amicrocontroller may contain one or more core processing units (CPUs)along with memory and programmable input/output peripherals. Programmemory in the form of Ferroelectric RAM, NOR flash or OTP ROM is alsooften included on chip, as well as a small amount of RAM.Microcontrollers may be employed for embedded applications, in contrastto the microprocessors used in personal computers or other generalpurpose applications consisting of various discrete chips.

As used herein, the term controller or microcontroller may be astand-alone IC or chip device that interfaces with a peripheral device.This may be a link between two parts of a computer or a controller on anexternal device that manages the operation of (and connection with) thatdevice.

Any of the processors or microcontrollers described herein, may beimplemented by any single core or multicore processor such as thoseknown under the trade name ARM Cortex by Texas Instruments. In oneaspect, the processor may be an LM4F230H5QR ARM Cortex-M4F ProcessorCore, available from Texas Instruments, for example, comprising on-chipmemory of 256 KB single-cycle flash memory, or other non-volatilememory, up to 40 MHz, a prefetch buffer to improve performance above 40MHz, a 32 KB single-cycle serial random access memory (SRAM), internalread-only memory (ROM) loaded with StellarisWare® software, 2 KBelectrically erasable programmable read-only memory (EEPROM), one ormore pulse width modulation (PWM) modules, one or more quadratureencoder inputs (QEI) analog, one or more 12-bit Analog-to-DigitalConverters (ADC) with 12 analog input channels, details of which areavailable for the product datasheet.

In one aspect, the processor may comprise a safety controller comprisingtwo controller-based families such as TMS570 and RM4x known under thetrade name Hercules ARM Cortex R4, also by Texas Instruments. The safetycontroller may be configured specifically for IEC 61508 and ISO 26262safety critical applications, among others, to provide advancedintegrated safety features while delivering scalable performance,connectivity, and memory options.

Modular devices include the modules (as described in connection withFIGS. 3 and 9 , for example) that are receivable within a surgical huband the surgical devices or instruments that can be connected to thevarious modules in order to connect or pair with the correspondingsurgical hub. The modular devices include, for example, intelligentsurgical instruments, medical imaging devices, suction/irrigationdevices, smoke evacuators, energy generators, ventilators, insufflators,and displays. The modular devices described herein can be controlled bycontrol algorithms. The control algorithms can be executed on themodular device itself, on the surgical hub to which the particularmodular device is paired, or on both the modular device and the surgicalhub (e.g., via a distributed computing architecture). In someexemplifications, the modular devices' control algorithms control thedevices based on data sensed by the modular device itself (i.e., bysensors in, on, or connected to the modular device). This data can berelated to the patient being operated on (e.g., tissue properties orinsufflation pressure) or the modular device itself (e.g., the rate atwhich a knife is being advanced, motor current, or energy levels). Forexample, a control algorithm for a surgical stapling and cuttinginstrument can control the rate at which the instrument's motor drivesits knife through tissue according to resistance encountered by theknife as it advances.

Long Distance Communication and Condition Handling of Devices and Data

Surgical procedures are performed by different surgeons at differentlocations, some with much less experience than others. For a givensurgical procedure, there are many parameters that can be varied toattempt to realize a desired outcome. For example, for a given surgicalprocedure which utilizes energy supplied by a generator, the surgeonoften relies on experience alone for determining which mode of energy toutilize, which level of output power to utilize, the duration of theapplication of the energy, etc., in order to attempt to realize thedesired outcome. To increase the likelihood of realizing desiredoutcomes for a plurality of different surgical procedures, each surgeonshould be provided with best practice recommendations which are based onimportant relationships identified within large, accurate data sets ofinformation associated with multiple surgical procedures performed inmultiple locations over time. However, there are many ways that suchdata sets can be rendered compromised, inaccurate, and/or unsecure,thereby calling into question the applicability of the best practicerecommendations derived therefrom. For example, for data sent from asource to a cloud-based system, the data can be lost while in transit tothe cloud-based system, the data can be corrupted while in transit tothe cloud-based system, the confidentiality of the data can be comprisedwhile in transit to the cloud-based system, and/or the content of thedata can be altered while in transit to the cloud-based system.

A plurality of operating rooms located in multiple locations can each beequipped with a surgical hub. When a given surgical procedure isperformed in a given operating room, the surgical hub can receive dataassociated with the surgical procedure and communicate the data to acloud-based system. Over time, the cloud-based system will receive largedata sets of information associated with the surgeries. The data can becommunicated from the surgical hubs to the cloud-based system in amanner which allows for the cloud-based system to (1) verify theauthenticity of the communicated data, (2) authenticate each of therespective surgical hubs which communicated the data, and (3) trace thepaths the data followed from the respective surgical hubs to thecloud-based system.

Accordingly, in one aspect, the present disclosure provides a surgicalhub for transmitting generator data associated with a surgical procedureto a cloud-based system communicatively coupled to a plurality ofsurgical hubs. The surgical hub comprises a processor and a memorycoupled to the processor. The memory stores instructions executable bythe processor to receive data from a generator, encrypt the data,generate a message authentication code (MAC) based on the data, generatea datagram comprising the encrypted data, the generated MAC, a sourceidentifier, and a destination identifier, and transmit the datagram to acloud-based system. The data is structured into a data packet comprisingat least two of the following fields: a field that indicates the sourceof the data, a unique time stamp, a field indicating an energy mode ofthe generator, a field indicating the power output of the generator, anda field indicating a duration of the power output of the generator. Thedatagram allows for the cloud-based system to decrypt the encrypted dataof the transmitted datagram, verify integrity of the data based on theMAC, authenticate the surgical hub as the source of the datagram, andvalidate a transmission path followed by the datagram between thesurgical hub and the cloud-based system. In various aspects, the presentdisclosure provides a control circuit to transmit generator dataassociated with a surgical procedure to a cloud-based systemcommunicatively coupled to a plurality of surgical hubs, as describedabove. In various aspects, the present disclosure provides anon-transitory computer-readable medium storing computer-readableinstructions which, when executed, causes a machine to transmitgenerator data associated with a surgical procedure to a cloud-basedsystem communicatively coupled to a plurality of surgical hubs, asdescribed above.

In another aspect, the present disclosure provides a cloud-based systemcommunicatively coupled to a plurality of surgical hubs. Each surgicalhub is configured to transmit generator data associated with a surgicalprocedure to the cloud-based system. The cloud-based system comprises aprocessor and a memory coupled to the processor. The memory storesinstructions executable by the processor to receive a datagram generatedby a surgical hub, decrypt the encrypted generator data of the receiveddatagram, verify integrity of the generator data based on the MAC,authenticate the surgical hub as the source of the datagram, andvalidate a transmission path followed by the datagram between thesurgical hub and the cloud-based system. The datagram comprisesgenerator data captured from a generator associated with the surgicalhub, a MAC generated by the surgical hub based on the generator data, asource identifier, and a destination identifier. The generator data hasbeen encrypted by the surgical hub. The encrypted generator data hasbeen structured into a data packet comprising at least two of thefollowing fields: a field that indicates the source of the data, aunique time stamp, a field indicating an energy mode, a field indicatingpower output, and a field indicating a duration of applied power.

In various aspects, the present disclosure provides a control circuit totransmit generator data associated with a surgical procedure to thecloud-based system. In various aspects, the present disclosure providesa non-transitory computer-readable medium storing computer-readableinstructions which, when executed, causes a machine to transmitgenerator data associated with a surgical procedure to the cloud-basedsystem.

In another aspect, the present disclosure provides a method, comprisingcapturing data from a combination generator of a surgical hub during asurgical procedure, wherein the combination generator is configured tosupply two or more different modes of energy. Encrypting the capturedgenerator data, generating a MAC based on the captured generator data,generating a datagram comprising the encrypted generator data, the MAC,a source identifier, and a destination identifier, and communicating thedatagram from the surgical hub to a cloud-based system. The datagramallows for the cloud-based system to authenticate integrity of thecommunicated generator data, authenticate the surgical hub as a sourceof the datagram, and determine a communication path followed by thedatagram between the surgical hub and the cloud-based system.

By sending captured generator data from a plurality of differentsurgical hubs to a cloud-based system, the cloud-based system is able toquickly build large data sets of information associated with multiplesurgical procedures performed in multiple locations over time.Furthermore, due to the composition of the respective datagrams, for agiven datagram, the cloud-based system is able to determine whether thedatagram was originally sent by one of the surgical hubs (sourcevalidation), thereby providing an indication that the generator datareceived at the cloud-based system is legitimate data. For the givendatagram, the cloud-based system is also able to determine whether thegenerator data received at the cloud-based system is identical to thegenerator data sent by the given surgical hub (data integrity), therebyallowing for the authenticity of the received generator data to beverified. Additionally, for the given datagram, the cloud-based systemis also able to re-trace the communication path followed by thedatagram, thereby allowing for enhanced troubleshooting if a datagramreceived by the cloud-based system was originally sent from a deviceother than the surgical hubs and/or if the content of the datagram wasaltered while in transit to the cloud-based system. Notably, the presentdisclosure references generator data in particular. Here, the presentdisclosure should not be limited as being able to process only generatordata. For example, the surgical hub 206 and/or the cloud-based system205 may process data received from any component (e.g., imaging module238, generator module 240, smoke evacuator module 226,suction/irrigation module 228, communication module 230, processormodule 232, storage array 234, smart device/instrument 235, non-contactsensor module 242, robot hub 222, a non-robotic surgical hub 206,wireless smart device/instrument 235, visualization system 208) of thesurgical system 202 that is coupled to the surgical hub 206 and/or datafrom any devices (e.g., endoscope 239, energy device 241) coupledto/through such components (e.g., see FIGS. 9-10 ), in a similar manneras discussed herein.

Unfortunately, the outcome of a surgical procedure is not alwaysoptimal. For example, a failure event such as a surgical device failure,an unwanted tissue perforation, an unwanted post-operative bleeding, orthe like can occur. The occurrence of a failure event can be attributedto any of a variety of different people and devices, including one ormore surgeons, one or more devices associated with the surgery, acondition of the patient, and combinations thereof. When a given failureevent occurs, it is not always clear regarding who or what caused thefailure event or how the occurrence of the failure event can bemitigated in connection with a future surgery.

During a given surgical procedure, a large amount of data associatedwith the surgical procedure can be generated and captured. All of thecaptured data can be communicated to a surgical hub, and the captureddata can be time-stamped either before or after being received at thesurgical hub. When a failure event associated with the surgicalprocedure is detected and/or identified, it can be determined which ofthe captured data is associated with the failure event and/or which ofthe captured data is not associated with the failure event. In makingthis determination, the failure event can be defined to include a periodof time prior to the detection/identification of the failure event. Oncethe determination is made regarding the captured data associated withthe failure event, the surgical hub can separate the captured dataassociated with the failure event from all other captured data, and thecaptured data can be separated based on tagging, flagging, or the like.The captured data associated with the failure event can then bechronologized based on the time-stamping and the defined time periodapplicable to the failure event. The chronologized captured data canthen be communicated to a cloud-based system on a prioritized basis foranalysis, where the prioritized basis is relative to the captured datawhich is not associated with the failure event. Whether or not theanalysis identifies a device associated with the surgical procedure asthe causation of the failure event, the surgical hub can tag the devicefor removal of the device from future use, further analysis of thedevice, and/or to return the device to the manufacturer.

When a given surgical procedure is performed, a large amount of dataassociated with the surgical procedure can be generated and captured.All of the captured data can be communicated to a surgical hub, wherethe information can be stripped of all “personal” associations. Thecaptured data can be time-stamped before being received at the surgicalhub, after being received at the surgical hub, before being stripped ofthe “personal” associations, or after being stripped of the “personal”associations. The surgical hub can communicate the stripped data to thecloud-based system for subsequent analysis. Over time, the cloud-basedsystem will receive large data sets of information associated with thesurgeries. Accordingly, in one aspect, the present disclosure provides asurgical hub for prioritizing surgical data associated with a surgicalprocedure to a cloud-based system communicatively coupled to a pluralityof surgical hubs. The surgical hub comprises a processor and a memorycoupled to the processor. The memory stores instructions executable bythe processor to capture surgical data, wherein the surgical datacomprises data associated with a surgical device, time-stamp thecaptured surgical data, identify a failure event, identify a time periodassociated with the failure event, isolate failure event surgical datafrom surgical data not associated with the failure event based on theidentified time period, chronologize the failure event surgical data bytime-stamp, encrypt the chronologized failure event surgical data,generate a datagram comprising the encrypted failure event surgicaldata, and transmit the datagram to a cloud-based system. The datagram isstructured to include a field which includes a flag that prioritizes theencrypted failure event surgical data over other encrypted data of thedatagram. The datagram allows for the cloud-based system to decrypt theencrypted failure event surgical data, focus analysis on the failureevent surgical data rather than surgical data not associated with thefailure event, and flag the surgical device associated with the failureevent for at least one of the following: removal from an operating room,return to a manufacturer, or future inoperability in the cloud-basedsystem.

In various aspects, the present disclosure provides a control circuit toprioritize surgical data associated with a surgical procedure to acloud-based system communicatively coupled to a plurality of surgicalhubs. In various aspects, the present disclosure provides anon-transitory computer-readable medium storing computer-readableinstructions which, when executed, causes a machine to prioritizesurgical data associated with a surgical procedure to a cloud-basedsystem communicatively coupled to a plurality of surgical hubs.

In another aspect, the present disclosure provides a method, comprisingcapturing data during a surgical procedure, communicating the captureddata to a surgical hub, time-stamping the captured data, identifying afailure event associated with the surgical procedure, determining whichof the captured data is associated with the failure event, separatingthe captured data associated with the failure event from all othercaptured data, chronologizing the captured data associated with thefailure event, and communicating the chronologized captured data to acloud-based system on a prioritized basis.

By capturing the large amount of data associated with the surgicalprocedure, and with having the captured data time-stamped, the portionof the captured data which is relevant to the detected/identifiedfailure event can be more easily isolated from all of the other captureddata, thereby allowing for a more focused subsequent analysis on justthe relevant captured data. The data associated with the failure eventcan then be chronologized (this requires less processing power thanchronologizing all of the captured data), thereby allowing for theevents leading up to the detection/identification of the failure eventto be more easily considered during the subsequent analysis of thefailure event. The chronologized data can then be communicated to thecloud-based system (this requires less communication resources thancommunicating all of the captured data at the same time) on aprioritized basis, thereby allowing for the focused subsequent analysisof the fault event to be performed by the cloud-based system in a moretime-sensitive manner.

To help ensure that the best practice recommendations are developedbased on accurate data, it would be desirable to ensure that thegenerator data received at the cloud-based system is the same as thegenerator data communicated to the cloud-based system. Also, to help tobe able to determine the cause of a failure event as quickly aspossible, it would be desirable to ensure that surgical data associatedwith the failure event is communicated to the cloud-based system in aprioritized manner (relative to surgical data not associated with thefailure event) so that analysis of the surgical data can be performed inan expedited manner.

Aspects of a system and method for communicating data associated with asurgical procedure are described herein. As shown in FIG. 9 , variousaspects of the computer implemented interactive surgical system 200includes a device/instrument 235, a generator module 240, a modularcontrol tower 236, and a cloud-based system 205. As shown in FIG. 10 ,the device/instrument 235, the generator module 240, and the modularcontrol tower 236 are components/portions of a surgical hub 206.

In various aspects, the generator module 240 of the surgical hub 206 cansupply radio-frequency energy such as monopolar radio-frequency energy,bipolar radio-frequency energy, and advanced bipolar energy and/orultrasonic energy to a device/instrument 235 for use in a surgicalprocedure. Thus, the generator module 240 may be referred to as acombination generator. An example of such a combination generator isshown in FIG. 22 , where the combination generator 3700 is shown asincluding a monopolar module 3702, a bipolar module 3704, an advancedbipolar module 3706, and an ultrasound module 3708. When utilized duringa surgical procedure, the respective energy modules (e.g., 3702, 3704,3706, and/or 3708) of the combination generator 3700 can providegenerator data such as type of energy supplied to the device instrument(e.g., radio-frequency energy, ultrasound energy, radio-frequency energyand ultrasound energy), type of radio-frequency energy (e.g., monopolar,bipolar, advanced bipolar), frequency, power output, duration, etc., tothe data communication module 3710 of the combination generator 3700.

FIG. 23 illustrates various aspects of a method of capturing data from acombination generator 3700 and communicating the captured generator datato a cloud-based system 205. Notably, as discussed herein, the presentdisclosure should not be limited to processing generator data. As such,the method of FIG. 23 similarly extends to other types of data receivedfrom other components coupled to the surgical hub 206 (e.g., imagingmodule data, smoke evacuator data, suction/irrigation data,device/instrument data). The method comprises (1) capturing 3712 datafrom a combination generator 3700 of a surgical hub 206 during asurgical procedure, wherein the combination generator 3700 is configuredto supply two or more different modes of energy; (2) encrypting 3714 thecaptured generator data; (3) generating 3716 a MAC based on the capturedgenerator data; (4) generating 3718 a datagram comprising the encryptedgenerator data, the MAC, a source identifier, and a destinationidentifier; and (5) communicating 3720 the datagram from the surgicalhub 206 to a cloud-based system 205, wherein the datagram allows for thecloud-based system 205 to (i) authenticate integrity of the communicatedgenerator data, (ii) authenticate the surgical hub as a source of thedatagram, and (iii) determine a communication path followed by thedatagram between the surgical hub 206 and the cloud-based system 205.

More specifically, once the generator data is received at the datacommunication module 3710 of the combination generator 3700, thegenerator data can be communicated to the modular communication hub 203of the surgical hub 206 for subsequent communication to the cloud-basedsystem 205. The data communication module 3710 can communicate thegenerator data to the modular communication hub 203 serially over asingle communication line or in parallel over a plurality ofcommunication lines, and such communication can be performed in realtime or near real time. Alternatively, such communication can beperformed in batches.

According to various aspects, prior to communicating the generator datato the modular communication hub 203, a component of the combinationgenerator 3700 (e.g., the data communication module 3710) can organizethe generator data into data packets. An example of such a data packetis shown in FIG. 24 , where the data packet 3722 includes a preamble3724 or self-describing data header which defines what the data is(e.g., combination generator data—CGD) and fields which indicate wherethe generator data came from [e.g., combination generator ID number3726—(e.g., 017), a unique time stamp 3728 (e.g., 08:27:16), the energymode utilized 3730 (e.g., RF, U, RF+U), the type of radio-frequencyenergy or radio frequency mode 3732 (e.g., MP, BP, ABP), the frequency3734 (e.g., 500 Khz), the power output 3736 (e.g., 30 watts), theduration of applied power 3738 (e.g., 45 milliseconds), and anauthentication/identification certificate of the data point 3740 (e.g.,01101011001011). The example data packet 3722 may be considered aself-describing data packet, and the combination generator 3700 andother intelligent devices (e.g., the surgical hub 206) can use theself-describing data packets to minimize data size and data-handlingresources. Again, as discussed herein, the present disclosure should notbe limited to processing generator data received from a combinationgenerator 3700. As such, the data packet 3722 of FIG. 24 similarlyextends to other types of data received from other components coupled tothe surgical hub 206. In one aspect, the data packet 3722 may comprisedata associated with endoscope 239 (e.g., image data) received from acomponent of the imaging module 238. In another aspect, the data packet3722 may comprises data associated with an evacuation system (e.g.,pressures, particle counts, flow rates, motor speeds) received from acomponent of the smoke evacuator module 226. In yet another aspect, thedata packet 3722 may comprise data associated with a device/instrument(e.g., temperature sensor data, firing data, sealing data) received froma component of the device/instrument 235. In various other aspects, thedata packet 3722 may similarly comprise data received from othercomponents coupled to the surgical hub 206 (e.g., suction/irrigationmodule 228, non-contact sensor module 242)

Additionally, the data communication module 3710 can compress thegenerator data and/or encrypt the generator data prior to communicatingthe generator data to the modular communication hub 203. The specificmethod of compressing and/or encrypting can be the same as or differentfrom the compressing and/or encrypting which may be performed by thesurgical hub 206 as described in more detail below.

The modular communication hub 203 can receive the generator datacommunicated from the combination generator 3700 (e.g., via the datacommunication module 3710), and the generator data can be subsequentlycommunicated to the cloud-based system 205 (e.g., through the Internet).According to various aspects, the modular communication hub 203 canreceive the generator data through a hub/switch 207/209 of the modularcommunication hub 203 (See FIG. 10 ), and the generator data can becommunicated to the cloud-based system 205 by a router 211 of themodular communication hub 203 (See FIG. 10 ). The generator data may becommunicated in real time, near real time, or in batches to thecloud-based system 205 or may be stored at the surgical hub 206 prior tobeing communicated to the cloud-based system 205. The generator data canbe stored, for example, at the storage array 234 or at the memory 249 ofthe computer system 210 of the surgical hub 206.

In various aspects, for instances where the generator data received atthe modular communication hub 203 is not encrypted, prior to thereceived generator data being communicated to the cloud-based system205, the generator data is encrypted to help ensure the confidentialityof the generator data, either while it is being stored at the surgicalhub 206 or while it is being transmitted to the cloud 204 using theInternet or other computer networks. According to various aspects, acomponent of the surgical hub 206 utilizes an encryption algorithm toconvert the generator data from a readable version to an encodedversion, thereby forming the encrypted generator data. The component ofthe surgical hub 206 which utilizes/executes the encryption algorithmcan be, for example, the processor module 232, the processor 244 of thecomputer system 210, and/or combinations thereof. The utilized/executedencryption algorithm can be a symmetric encryption algorithm and/or anasymmetric encryption algorithm.

Using a symmetric encryption algorithm, the surgical hub 206 wouldencrypt the generator data using a shared secret (e.g., private key,passphrase, password). In such an aspect, a recipient of the encryptedgenerator data (e.g., cloud-based system 205) would then decrypt theencrypted generator data using the same shared secret. In such anaspect, the surgical hub 206 and the recipient would need access toand/or knowledge of the same shared secret. In one aspect, a sharedsecret can be generated/chosen by the surgical hub 206 and securelydelivered (e.g., physically) to the recipient before encryptedcommunications to the recipient.

Alternatively, using an asymmetric encryption algorithm, the surgicalhub 206 would encrypt the generator data using a public key associatedwith a recipient (e.g., cloud-based system 205). This public key couldbe received by the surgical hub 206 from a certificate authority thatissues a digital certificate certifying the public key as owned by therecipient. The certificate authority can be any entity trusted by thesurgical hub 206 and the recipient. In such an aspect, the recipient ofthe encrypted generator data would then decrypt the encrypted generatordata using a private key (i.e., known only by the recipient) paired tothe public key used by the surgical hub 206 to encrypt the generatordata. Notably, in such an aspect, the encrypted generator data can onlybe decrypted using the recipient's private key.

According to aspects of the present disclosure, components (e.g.,surgical device/instrument 235, energy device 241, endoscope 239) of thesurgical system 202 are associated with unique identifiers, which can bein the form of serial numbers. As such, according to various aspects ofthe present disclosure, when a component is coupled to a surgical hub206, the component may establish a shared secret with the surgical hub206 using the unique identifier of the coupled component as the sharedsecret. Further, in such an aspect, the component may derive a checksumvalue by applying a checksum function/algorithm to the unique identifierand/or other data being communicated to the surgical hub 206. Here, thechecksum function/algorithm is configured to output a significantlydifferent checksum value if there is a modification to the underlyingdata.

In one aspect, the component may initially encrypt the unique identifierof a coupled component using a public key associated with the surgicalhub (e.g., received by the component from the surgical hub 206upon/after connection) and communicate the encrypted unique identifierto the surgical hub 206. In other aspects, the component may encrypt theunique identifier and the derived checksum value of a coupled componentusing a public key associated with the surgical hub 206 and communicatethe encrypted unique identifier and linked/associated checksum value tothe surgical hub 206.

In yet other aspects, the component may encrypt the unique identifierand a checksum function/algorithm using a public key associated with thesurgical hub 206 and communicate the encrypted unique identifier and thechecksum function/algorithm to the surgical hub 206. In such aspects,the surgical hub 206 would then decrypt the encrypted unique identifieror the encrypted unique identifier and the linked/associated checksumvalue or the encrypted unique identifier and the checksumfunction/algorithm using a private key (i.e., known only by the surgicalhub 206) paired to the public key used by the component to encrypt theunique identifier.

Since the encrypted unique identifier can only be decrypted using thesurgical hub's 206 private key and the private key is only known by thesurgical hub, this is a secure way to communicate a shared secret (e.g.,the unique identifier of the coupled component) to the surgical hub 206.Further, in aspects where a checksum value is linked to/associated withthe unique identifier, the surgical hub 206 may apply the same checksumfunction/algorithm to the decrypted unique identifier to generate avalidating checksum value. If the validating checksum value matches thedecrypted checksum value, the integrity of the decrypted uniqueidentifier is further verified. Further, in such aspects, with a sharedsecret established, the component can encrypt future communications tothe surgical hub 206, and the surgical hub 206 can decrypt the futurecommunications from the component using the shared secret (e.g., theunique identifier of the coupled component). Here, according to variousaspects, a checksum value may be derived for and communicated with eachcommunication between the component and the surgical hub 206 (e.g., thechecksum value based on the communicated data or at least a designatedportion thereof). Here, a checksum function/algorithm (e.g., known bythe surgical hub 206 and/or component or communicated when establishingthe shared secret between the surgical hub 206 and the component asdescribed above) may be used to generate validating checksum values forcomparison with communicated checksum values to further verify theintegrity of communicated data in each communication.

Notably, asymmetric encryption algorithms may be complex and may requiresignificant computational resources to execute each communication. Assuch, establishing the unique identifier of the coupled component as theshared secret is not only quicker (e.g., no need to generate a sharedsecret using a pseudorandom key generator) but also increasescomputational efficiency (e.g., enables the execution of faster, lesscomplex symmetric encryption algorithms) for all subsequentcommunications. In various aspects, this established shared secret maybe utilized by the component and surgical hub 206 until the component isdecoupled from the surgical hub (e.g., surgical procedure ended).

According to other aspects of the present disclosure, components (e.g.,surgical device/instrument 235, energy device 241, endoscope 239) of thesurgical system 202 may comprise sub-components (e.g., handle, shaft,end effector, cartridge) each associated with its own unique identifier.As such, according to various aspects of the present disclosure, when acomponent is coupled to the surgical hub 206, the component mayestablish a shared secret with the surgical hub 206 using a uniquecompilation/string (e.g., ordered or random) of the unique identifiersassociated with the sub-components that combine to form the coupledcomponent. In one aspect, the component may initially encrypt the uniquecompilation/string of the coupled component using a public keyassociated with the surgical hub 206 and communicate the encryptedunique compilation/string to the surgical hub 206. In such an aspect,the surgical hub 206 would then decrypt the encrypted uniquecompilation/string using a private key (i.e., known only by the surgicalhub 206) paired to the public key used by the component to encrypt theunique compilation/string. Since the encrypted unique compilation/stringcan only be decrypted using the surgical hub's 206 private key and theprivate key is only known by the surgical hub 206, this is a secure wayto communicate a shared secret (e.g., the unique compilation/string ofthe coupled component) to the surgical hub 206. Further, in such anaspect, with a shared secret established, the component can encryptfuture communications to the surgical hub 206, and the surgical hub 206can decrypt the future communications from the component using theshared secret (e.g., the unique compilation/string of the coupledcomponent).

Again, asymmetric encryption algorithms may be complex and may requiresignificant computational resources to execute each communication. Assuch, establishing the unique compilation/string of the coupledcomponent (i.e., readily combinable by the component) as the sharedsecret is not only quicker (e.g., no need to generate a shared secretusing a pseudorandom key generator) but also increases computationalefficiency (e.g., enables the execution of faster, less complexsymmetric encryption algorithms) for all subsequent communications. Invarious aspects, this established shared secret may be utilized by thecomponent and surgical hub 206 until the component is decoupled from thesurgical hub 206 (e.g., surgical procedure ended). Furthermore, in suchan aspect, since various sub-components may be reusable (e.g., handle,shaft, end effector) while other sub-components may not be reusable(e.g., end effector, cartridge) each new combination of sub-componentsthat combine to form the coupled component provide a uniquecompilation/string usable as a shared secret for componentcommunications to the surgical hub 206.

According to further aspects of the present disclosure, components(e.g., surgical device/instrument 235, energy device 241, endoscope 239)of the surgical system 202 are associated with unique identifiers. Assuch, according to various aspects of the present disclosure, when acomponent is coupled to the surgical hub 206, the surgical hub 206 mayestablish a shared secret with a recipient (e.g., cloud-based system205) using the unique identifier of the coupled component. In oneaspect, the surgical hub 206 may initially encrypt the unique identifierof a coupled component using a public key associated with the recipientand communicate the encrypted unique identifier to the recipient. Insuch an aspect, the recipient would then decrypt the encrypted uniqueidentifier using a private key (i.e., known only by the recipient)paired to the public key used by the surgical hub 206 to encrypt theunique identifier. Since the encrypted unique identifier can only bedecrypted using the recipient's private key and the private key is onlyknown by the recipient, this is a secure way to communicate a sharedsecret (e.g., the unique identifier of the coupled component) to therecipient (e.g., cloud-based system). Further in such an aspect, with ashared secret established, the surgical hub 206 can encrypt futurecommunications to the recipient (e.g., cloud-based system 205), and therecipient can decrypt the future communications from the surgical hub206 using the shared secret (e.g., the unique identifier of the coupledcomponent).

Notably, asymmetric encryption algorithms may be complex and may requiresignificant computational resources to execute each communication. Assuch, establishing the unique identifier of the coupled component (i.e.,already available to the surgical hub 206) as the shared secret is notonly quicker (e.g., no need to generate a shared secret using apseudorandom key generator) but also increases computational efficiencyby, for example, enabling the execution of faster, less complexsymmetric encryption algorithms for all subsequent communications. Invarious aspects, this established shared secret may be utilized by thesurgical hub 206 until the component is decoupled from the surgical hub(e.g., surgical procedure ended).

According to yet further aspects of the present disclosure, components(e.g., surgical device/instrument 235, energy device 241, endoscope 239)of the surgical system 202 may comprise sub-components (e.g., handle,shaft, end effector, cartridge) each associated with its own uniqueidentifier. As such, according to various aspects of the presentdisclosure, when a component is coupled to the surgical hub 206, thesurgical hub 206 may establish a shared secret with a recipient (e.g.,cloud-based system 205) using a unique compilation/string (e.g., orderedor random) of the unique identifiers associated with the sub-componentsthat combine to form the coupled component.

In one aspect, the surgical hub 206 may initially encrypt the uniquecompilation/string of the coupled component using a public keyassociated with the recipient and communicate the encrypted uniquecompilation/string to the recipient. In such an aspect, the recipientwould then decrypt the encrypted unique compilation/string using aprivate key (i.e., known only by the recipient) paired to the public keyused by the surgical hub 206 to encrypt the unique compilation/string.Since the encrypted unique compilation/string can only be decryptedusing the recipient's private key and the private key is only known bythe recipient, this is a secure way to communicate a shared secret(e.g., the unique compilation/string of the coupled component) to therecipient. With a shared secret established, the surgical hub 206 canencrypt future communications to the recipient (e.g., cloud-based system205), and the recipient can decrypt the future communications from thesurgical hub 206 using the shared secret (e.g., the uniquecompilation/string of the coupled component). Again, asymmetricencryption algorithms may be complex and may require significantcomputational resources to execute each communication. As such,establishing the unique compilation/string of the coupled component(i.e., readily combinable by the surgical hub 206) as the shared secretis not only quicker (e.g., no need to generate a shared secret using apseudorandom key generator) but also increases computational efficiency(e.g., enables the execution of faster, less complex symmetricencryption algorithms) for all subsequent communications.

In various aspects, this established shared secret may be utilized bythe surgical hub 206 until the component is decoupled from the surgicalhub (e.g., surgical procedure ended). Furthermore, in such an aspect,since various sub-components may be reusable (e.g., handle, shaft, endeffector) while other sub-components may not be reusable (e.g., endeffector, cartridge) each new combination of sub-components that combineto form the coupled component provide a unique compilation/string usableas a shared secret for surgical hub 206 communications to the recipient.

In some aspects, an encrypt-then-MAC (EtM) approach may be utilized toproduce the encrypted generator data. An example of this approach isshown in FIG. 25 , where the non-encrypted generator data (i.e., theplaintext 3742, e.g., data packet 3722) is first encrypted 3743 (e.g.,via key 3746) to produce a ciphertext 3744 (i.e., the encryptedgenerator data), then a MAC 3745 is produced based on the resultingciphertext 3744, the key 3746, and a MAC algorithm (e.g., a hashfunction 3747). More specifically, the ciphertext 3744 is processedthrough the MAC algorithm using the key 3746. In one aspect similar tosymmetric encryption discussed herein, the key 3746 is a secret keyaccessible/known by the surgical hub 206 and the recipient (e.g.,cloud-based system 205). In such an aspect, the secret key is a sharedsecret associated with/chosen by the surgical hub 206, a shared secretassociated with/chosen by the recipient, or a key selected via apseudorandom key generator. For this approach, as shown generally at3748, the encrypted generator data (i.e., the ciphertext 3744) and theMAC 3745 would be communicated together to the cloud-based system 205.

In other aspects, an encrypt-and-MAC (E&M) approach may be utilized toproduce the encrypted generator data. An example of this approach isshown in FIG. 26 , where the MAC 3755 is produced based on thenon-encrypted generator data (i.e., the plaintext 3752, e.g., datapacket 3722), a key 3756, and a MAC algorithm (e.g., a hash function3757). More specifically, the plaintext 3752 is processed through theMAC algorithm using the key 3756. In one aspect similar to symmetricencryption discussed herein, the key 3756 is a secret keyaccessible/known by the surgical hub 206 and the recipient (e.g.,cloud-based system 205). In such an aspect, the secret key is a sharedsecret associated with/chosen by the surgical hub 206, a shared secretassociated with/chosen by the recipient, or a key selected via apseudorandom key generator. Further, in such an aspect, thenon-encrypted generator data (i.e., the plaintext 3752, e.g., datapacket 3722) is encrypted 3753 (e.g., via key 3756) to produce aciphertext 3754. For this approach, as shown generally at 3758, the MAC3755 (i.e., produced based on the non-encrypted generator data) and theencrypted generator data (i.e., the ciphertext 3754) would becommunicated together to the cloud-based system 205.

In yet other aspects, a MAC-then-encrypt (MtE) approach may be utilizedto produce the encrypted generator data. An example of this approach isshown in FIG. 27 , where the MAC 3765 is produced based on thenon-encrypted generator data (i.e., the plaintext 3762), a key 3766, anda MAC algorithm (e.g., a hash function 3767). More specifically, theplaintext 3762 is processed through the MAC algorithm using the key3766. In one aspect similar to symmetric encryption discussed herein,the key 3766 is a secret key accessible/known by the surgical hub 206and the recipient (e.g., cloud-based system 205). In such an aspect, thesecret key is a shared secret associated with/chosen by the surgical hub206, a shared secret associated with/chosen by the recipient, or a keyselected via a pseudorandom key generator. Next, the non-encryptedgenerator data (i.e., the plaintext 3762) and the MAC 3765 are togetherencrypted 3763 (e.g., via key 3766) to produce a ciphertext 3764 basedon both. For this approach, as shown generally at 3768, the ciphertext3764 (i.e., which includes the encrypted generator data and theencrypted MAC 3765) would be communicated to the cloud-based system 205.

In alternative aspects, the key used to encrypt the non-encryptedgenerator data (e.g., FIG. 25 and FIG. 26 ) or the non-encryptedgenerator data and the MAC (e.g., FIG. 27 ) may be different from thekey (e.g., keys 3746, 3756, 3766) used to produce the MAC. For example,the key used to encrypt the non-encrypted generator data (e.g., FIG. 25and FIG. 26 ) or the non-encrypted generator data and the MAC (e.g.,FIG. 27 ) may be a different shared secret or a public key associatedwith the recipient.

In lieu of utilizing the MAC to provide for a subsequent assurance ofdata integrity to the cloud-based system 205, according to otheraspects, the surgical hub 206 can utilize a digital signature to allowthe cloud-based system 205 to subsequently authenticate integrity of thecommunicated generator data. For example, the processor module 232and/or the processor 244 of the computer system 210 can utilize one ormore algorithms to generate a digital signature associated with thegenerator data, and the cloud-based system 205 can utilize an algorithmto determine the authenticity of the received generator data. Thealgorithms utilized by the processor module 232 and/or the processor 244of the computer system 210 can include: (1) a key generation algorithmthat selects a private key uniformly at random from a set of possibleprivate keys, where the key generation algorithm outputs the private keyand a corresponding public key; and (2) a signing algorithm that, giventhe generator data and a private key, produces a digital signatureassociated with the generator data. The cloud-based system 205 canutilize a signature verifying algorithm that, given the receivedgenerator data, public key, and digital signature, can accept thereceived generator data as authentic if the digital signature isdetermined to be authentic or consider the generator data to becompromised or altered if the digital signature is not determined to beauthentic.

According to other aspects of the present disclosure, the surgical hub206 can utilize a commercial authentication program (e.g., Secure HashAlgorithm, SHA-2 comprising SHA-256) to provide for a subsequentassurance of data integrity of the communicated generator data to thecloud-based system 205.

After the generator data has been encrypted (e.g., via EtM, E&M, MtE), acomponent of the surgical hub 206 can communicate the encryptedgenerator data to the cloud-based system 205. The component of thesurgical hub 206 which communicates the encrypted generator data to thecloud-based system 205 can be, for example, the processor module 232, ahub/switch 207/209 of the modular communication hub 203, the router 211of the modular communication hub 203, the communication module 247 ofthe computer system 210, etc.

According to various aspects, the communication of the encryptedgenerator data through the Internet can follow an IP which: (1) definesdatagrams that encapsulate the encrypted generator data to be deliveredand/or (2) defines addressing methods that are used to label thedatagram with source and destination information. A high-levelrepresentation of an example datagram 3770 is shown in FIG. 28 , wherethe datagram 3770 includes a header 3772 and a payload 3774, and inother aspects also may include a trailer (not shown). A more detailedrepresentation of an example datagram 3780 is shown in FIG. 29 , wherethe header 3782 can include fields for information such as, for example,the IP address of the source 3786 which is sending the datagram (e.g.,the router 211 of the modular communication hub 203), the IP address ofthe destination 3788 which is to receive the datagram (e.g., the cloud204 and/or the remote server 213 associated with the cloud-based system205), a type of service designation (not shown), a header length 3790, apayload length 3792, and a checksum value 3794. In such an aspect, thesurgical hub 206 may further apply a checksum function/algorithm to thenon-encrypted generator data (i.e., the plaintext 3742, e.g., datapacket 3722) or at least a portion of the non-encrypted generator data(e.g., combination generator ID 3726) to derive the checksum value 3794.Here, the checksum function/algorithm is configured to output asignificantly different checksum value if there is any modification(e.g., even a slight change) to the underlying data (e.g., generatordata). After decryption of the encrypted generator data by its recipient(e.g., cloud-based system 205), the recipient may apply the samechecksum function/algorithm to the decrypted generator data to generatea validating checksum value. If the validating checksum value matchesthe checksum value 3794 (i.e., stored in the header 3782 of the receiveddatagram 3780), the integrity of the received generator data is furtherverified. The payload 3784 may include the encrypted generator data 3796and can also include padding 3798 if the encrypted generator data 3796is less than a specified payload length. Notably, the communicatedencrypted generator data 3796 may comprise a MAC as discussed in FIGS.25, 26, and 27 above (e.g., references 3748, 3758, and 3768,respectively). In some aspects, the header 3782 can further include aspecific path the datagram is to follow when the datagram iscommunicated from the surgical hub 206 to the cloud-based system 205(e.g., from IP address of the source, to IP address of at least oneintermediate network component (e.g., specified routers, specifiedservers), to IP address of the destination).

According to various aspects, prior to the generator data beingencrypted, the generator data can be time-stamped (if not alreadytime-stamped by the combination generator 3700) and/or the generatordata can be compressed (if not already compressed by the combinationgenerator 3700). Time-stamping allows for the cloud-based system 205 tocorrelate the generator data with other data (e.g., stripped patientdata) which may be communicated to the cloud-based system 205. Thecompression allows for a smaller representation of the generator data tobe subsequently encrypted and communicated to the cloud-based system205. For the compression, a component of the surgical hub 206 canutilize a compression algorithm to convert a representation of thegenerator data to a smaller representation of the generator data,thereby allowing for a more efficient and economical encryption of thegenerator data (e.g., less data to encrypt utilizes less processingresources) and a more efficient and economical communication of theencrypted generator data (e.g., smaller representations of the generatordata within the payload of the datagrams (e.g., FIGS. 28 and 29 ) allowfor more generator data to be included in a given datagram, for moregenerator data to be communicated within a given time period, and/or forgenerator data to be communicated with fewer communication resources).The component of the surgical hub 206 which utilizes/executes thecompression algorithm can be, for example, the processor module 232, theprocessor 244 of the computer system, and/or combinations thereof. Theutilized/executed compression algorithm can be a lossless compressionalgorithm or a lossy compression algorithm.

Once the generator data and the MAC for a given datagram has beenreceived at the cloud-based system 205 (e.g., FIG. 25 , reference 3748;FIG. 26 , reference 3758; and FIG. 27 , reference 3768), the cloud-basedsystem 205 can decrypt the encrypted generator data from the payload ofthe communicated datagram to realize the communicated generator data.

In one aspect, referring back to FIG. 25 , the recipient (e.g.,cloud-based system 205) may, similar to the surgical hub 206, processthe ciphertext 3744 through the same MAC algorithm using the sameknown/accessible secret key to produce an authenticating MAC. If thereceived MAC 3745 matches this authenticating MAC, the recipient (e.g.,cloud-based system 205) may safely assume that the ciphertext 3744 hasnot been altered and is from the surgical hub 206. The recipient (e.g.,cloud-based system 205) may then decrypt the ciphertext 3744 (e.g., viakey 3746) to realize the plaintext 3742 (e.g., data packet comprisinggenerator data).

In another aspect, referring back to FIG. 26 , the recipient (e.g.,cloud-based system 205) may decrypt the ciphertext 3754 (e.g., via key3756) to realize the plaintext 3752 (e.g., data packet comprisinggenerator data). Next, similar to the surgical hub 206, the recipient(e.g., cloud-based system 205) may process the plaintext 3752 throughthe same MAC algorithm using the same known/accessible secret key toproduce an authenticating MAC. If the received MAC 3755 matches thisauthenticating MAC, the recipient (e.g., cloud-based system 205) maysafely assume that the plaintext 3752 has not been altered and is fromthe surgical hub 206.

In yet another aspect, referring back to FIG. 27 , the recipient (e.g.,cloud-based system 205) may decrypt the ciphertext 3764 (e.g., via key3766) to realize the plaintext 3762 (e.g., data packet comprisinggenerator data) and the MAC 3765. Next, similar to the surgical hub 206,the recipient (e.g., cloud-based system 205) may process the plaintext3762 through the same MAC algorithm using the same known/accessiblesecret key to produce an authenticating MAC. If the received MAC 3765matches this authenticating MAC, the recipient (e.g., cloud-based system205) may safely assume that the plaintext 3762 has not been altered andis from the surgical hub 206.

In alternative aspects, the key used to encrypt the non-encryptedgenerator data (e.g., FIG. 25 and FIG. 26 ) or the non-encryptedgenerator data and the MAC (e.g., FIG. 27 ) may be different from thekey (e.g., keys 3746, 3756, 3766) used to produce the MAC. For example,the key used to encrypt the non-encrypted generator data (e.g., FIG. 25and FIG. 26 ) or the non-encrypted generator data and the MAC (e.g.,FIG. 27 ) may be a different shared secret or a public key associatedwith the recipient. In such aspects, referring to FIG. 25 , therecipient (e.g., cloud-based system 205) may, after verifying theauthenticating MAC via key 3746 (described above), then decrypt theciphertext 3744 (e.g., via the different shared secret or private keyassociated with the recipient) to realize the plaintext 3742 (e.g., datapacket comprising generator data). In such aspects, referring to FIG. 26, the recipient may decrypt the ciphertext 3754 (e.g., via the differentshared secret or private key associated with the recipient) to realizethe plaintext 3752 (e.g., data packet comprising generator data), thenverify the authenticating MAC via key 3756 (described above). In suchaspects, referring to FIG. 27 , the recipient may decrypt the ciphertext3764 (e.g., via the different shared secret or private key associatedwith the recipient) to realize the plaintext 3762 (e.g., data packetcomprising generator data) and the MAC 3765, then verify theauthenticating MAC via key 3766 (described above).

In sum, referring to FIGS. 25-27 , if an authenticating MAC, asdetermined/calculated by the cloud-based system 205, is the same as theMAC which was received with the datagram, the cloud-based system 205 canhave confidence that the received generator data is authentic (i.e., itis the same as the generator data which was communicated by the surgicalhub 206) and that the data integrity of the communicated generator datahas not been compromised or altered. As described above, the recipientmay further apply the plaintext 3742, 3752, 3762, or at least a portionthereof to the same checksum function/algorithm (i.e., used by thesurgical hub 206) to generate a validating checksum value to furtherverify the integrity of the generator data based on the checksum valuestored in the header of the communicated datagram.

Additionally, based on the decrypted datagram, the IP address of thesource (e.g., FIG. 29 , reference 3786) which originally communicatedthe datagram to the cloud-based system 205 can be determined from theheader of the communicated datagram. If the determined source is arecognized source, the cloud-based system 205 can have confidence thatthe generator data originated from a trusted source, thereby providingsource authentication and even more assurance of the data integrity ofthe generator data. Furthermore, since each router the datagram passedthrough in route to the cloud-based system 205 includes its IP addresswith its forwarded communication, the cloud-based system 205 is able totrace back the path followed by the datagram and identify each routerwhich handled the datagram. The ability to identify the respectiverouters can be helpful in instances where the content of the datagramreceived at the cloud-based system 205 is not the same as the content ofthe datagram as originally communicated by the surgical hub 206. Foraspects where the communication path was pre-specified and included inthe header of the communicated datagram, the ability to identify therespective routers can allow for path validation and provide additionalconfidence of the authenticity of the received generator data.

Furthermore, according to various aspects, after authenticating thereceived generator data, the cloud-based system 205 can communicate amessage (e.g., a handshake or similar message) to the surgical hub 206via the Internet or another communication network,confirming/guaranteeing that the datagram communicated from the surgicalhub 206 was received intact by the cloud-based system 205, therebyeffectively closing the loop for that particular datagram.

Aspects of the above-described communication method, and/or variationsthereof, can also be employed to communicate data other than generatordata to the cloud-based system 205 and/or to communicate generator dataand/or other data from the surgical hub 206 to systems and/or devicesother than the cloud-based system 205. For example, according to variousaspects, the generator data and/or other data can be communicated fromthe surgical hub 206 to a hand-held surgical device/instrument (e.g.,wireless device/instrument 235), to a robotic interface of a surgicaldevice/instrument (e.g., robot hub 222) and/or to other servers,including servers (e.g., similar to server 213) associated with othercloud-based systems (e.g., similar to cloud-based system 205) inaccordance with the above-described communication method. For example,in certain instances, an EEPROM chip of a given surgical instrument caninitially be provided with merely an electronic chip device ID. Uponconnection of the given surgical instrument to the combination generator3700, data can be downloaded from the cloud-based system 205 to thesurgical hub 206 and subsequently to the EEPROM of the surgicalinstrument in accordance with the above-described communication method.

In addition to communicating generator data to the cloud-based system205, the surgical hub 206 can also utilize the above-described method ofcommunication, and/or variations thereof, to communicate data other thangenerator data to the cloud-based system 205. For example, the surgicalhub 206 can also communicate other information associated with thesurgical procedure to the cloud-based system 205. Such other informationcan include, for example, the type of surgical procedure beingperformed, the name of the facility where the surgical procedure isbeing performed, the location of the facility where the surgicalprocedure is being performed, an identification of the operating roomwithin the facility where the surgical procedure is being performed, thename of the surgeon performing the surgical procedure, the age of thepatient, and data associated with the condition of the patient (e.g.,blood pressure, heart rate, current medications). According to variousaspects, such other information may be stripped of all information whichcould identify the specific surgery, the patient, or the surgeon, sothat the information is essentially anonymized for further processingand analysis by the cloud-based system 205. In other words, the strippeddata is not correlated to a specific surgery, patient, or surgeon. Thestripped information can be communicated to the cloud-based system 205either together with or distinct from the communicated generator data.

For instances where the stripped/other data is to be communicated apartfrom the generator data, the stripped/other data can be time-stamped,compressed, and/or encrypted in a manner identical to or different fromthat described above regarding the generator data, and the surgical hub206 may be programmed/configured to generate a datagram which includesthe encrypted stripped/other information in lieu of the encryptedgenerator data. The datagram can then be communicated from the surgicalhub 206 through the Internet to the cloud-based system 205 following anIP which: (1) defines datagrams that encapsulate the encryptedstripped/other data to be delivered, and (2) defines addressing methodsthat are used to label the datagram with source and destinationinformation.

For instances where the stripped/other information is to be communicatedwith the generator data, the stripped/other data can be time-stamped,compressed, and/or encrypted in a manner identical to or different fromthat described above regarding the generator data, and the surgical hub206 may be programmed/configured to generate a datagram which includesboth the encrypted generator data and the encrypted stripped/otherinformation. An example of such a datagram in shown in FIG. 30 , wherethe payload 3804 of the datagram 3800 is divided into two or moredistinct payload data portions (e.g., one for the encrypted generatordata 3834, one for the encrypted stripped/other information 3836), witheach portion having an identifying bit (e.g., generator data (GD) 3806,other data (OD) 3812), the associated encrypted data 3808, 3814, and theassociated padding 3810, 3816, if needed, respectively. Further, asshown in FIG. 30 , the header 3802 may be the same as (e.g., IP addresssource 3818, IP address destination 3820, header length 3822) ordifferent from the header 3782 described with reference to the datagram3780 shown in FIG. 29 . For example, the header 3802 may be different inthat the header 3802 further includes a field designating the number ofpayload data portions 3824 (e.g., 2) included in the payload 3804 of thedatagram 3800. The header 3802 can also be different in that it caninclude fields designating the payload length 3826, 3830 and thechecksum value 3828, 2832 for each payload data portion 3834, 3836,respectively. Although only two payload data portions are shown in FIG.30 , it will be appreciated that the payload 3804 of the datagram 3800may include any quantity/number of payload data portions (e.g., 1, 2, 3,4, 5), where each payload data portion includes data associated with adifferent aspect of the surgical procedure. The datagram 3800 can thenbe communicated from the surgical hub 206 through the Internet to thecloud-based system 205 following an IP which: (1) defines datagrams thatencapsulate the encrypted generator data and the encryptedstripped/other data to be delivered, and (2) defines addressing methodsthat are used to label the datagram with source and destinationinformation.

As set forth above, it is an unfortunate reality that the outcomes ofall surgical procedures are not always optimal and/or successful. Forinstances where a failure event is detected and/or identified, avariation of the above-described communication methods can be utilizedto isolate surgical data which is associated with the failure event(e.g., failure event surgical data) from surgical data which is notassociated with the failure event (e.g., non-failure event surgicaldata) and communicate the surgical data which is associated with thefailure event (e.g., failure event data) from the surgical hub 206 tothe cloud-based system 205 on a prioritized basis for analysis.According to one aspect of the present disclosure, failure eventsurgical data is communicated from the surgical hub 206 to thecloud-based system 205 on a prioritized basis relative to non-failureevent surgical data.

FIG. 31 illustrates various aspects of a system-implemented method ofidentifying surgical data associated with a failure event (e.g., failureevent surgical data) and communicating the identified surgical data to acloud-based system 205 on a prioritized basis. The method comprises (1)receiving 3838 surgical data at a surgical hub 206, wherein the surgicaldata is associated with a surgical procedure; (2) time-stamping 3840 thesurgical data; (3) identifying 3842 a failure event associated with thesurgical procedure; (4) determining 3844 which of the surgical data isassociated with the failure event (e.g., failure event surgical data);(5) separating 3846 the surgical data associated with the failure eventfrom all other surgical data (e.g., non-failure event surgical data)received at the surgical hub 206; (6) chronologizing 3848 the surgicaldata associated with the failure event; (7) encrypting 3850 the surgicaldata associated with the failure event; and (8) communicating 3852 theencrypted surgical data to a cloud-based system 205 on a prioritizedbasis.

More specifically, various surgical data can be captured during asurgical procedure and the captured surgical data, as well as othersurgical data associated with the surgical procedure, can becommunicated to the surgical hub 206. The surgical data can include, forexample, data associated with a surgical device/instrument (e.g., FIG. 9, surgical device/instrument 235) utilized during the surgery, dataassociated with the patient, data associated with the facility where thesurgical procedure was performed, and data associated with the surgeon.Either prior to or subsequent to the surgical data being communicated toand received by the surgical hub 206, the surgical data can betime-stamped and/or stripped of all information which could identify thespecific surgery, the patient, or the surgeon, so that the informationis essentially anonymized for further processing and analysis by thecloud-based system 205.

Once a failure event has been detected and/or identified (e.g., whichcan be either during or after the surgical procedure), the surgical hub206 can determine which of the surgical data is associated with thefailure event (e.g., failure event surgical data) and which of thesurgical data is not associated with the surgical event (e.g.,non-failure event surgical data). According to one aspect of the presentdisclosure, a failure event can include, for example, a detection of oneor more misfired staples during a stapling portion of a surgicalprocedure. For example, in one aspect, referring to FIG. 9 , anendoscope 239 may take snapshots while a surgical device/instrument 235comprising an end effector including a staple cartridge performs astapling portion of a surgical procedure. In such an aspect, an imagingmodule 238 may compare the snapshots to stored images and/or imagesdownloaded from the cloud-based system 205 that convey correctly firedstaples to detect a misfired staple and/or evidence of a misfired staple(e.g., a leak). In another aspect, the imaging module 238 may analyzethe snapshots themselves to detect a misfired staple and/or evidence ofa misfired staple. In one alternative aspect, the surgical hub 206 maycommunicate the snapshots to the cloud-based system 205, and a componentof the cloud-based system 205 may perform the various imaging modulefunctions described above to detect a misfired staple and/or evidence ofa misfired staple and to report the detection to the surgical hub 206.According to another aspect of the present disclosure, a failure eventcan include a detection of a tissue temperature which is below theexpected temperature during a tissue-sealing portion of a surgicalprocedure and/or a visual indication of excessive bleeding or oozingfollowing a surgical procedure (e.g., FIG. 9 , via endoscope 239). Forexample, in one aspect, referring to FIG. 9 , the surgicaldevice/instrument 235 may comprise an end effector, including atemperature sensor and the surgical hub 206, and/or the cloud-basedsystem may compare at least one temperature detected by the temperaturesensor (e.g., during a tissue-sealing portion of a surgical procedure)to a stored temperature and/or a range of temperatures expected and/orassociated with that surgical procedure to detect an inadequate/lowsealing temperature. In another aspect, an endoscope 239 may takesnapshots during a surgical procedure. In such an aspect, an imagingmodule 238 may compare the snapshots to stored images and/or imagesdownloaded from the cloud-based system 205 that convey tissue correctlysealed at expected temperatures to detect evidence of animproper/insufficient sealing temperature (e.g., charring,oozing/bleeding). Further, in such an aspect, the imaging module 238 mayanalyze the snapshots themselves to detect evidence of animproper/insufficient sealing temperature (e.g., charring,oozing/bleeding). In one alternative aspect, the surgical hub 206 maycommunicate the snapshots to the cloud-based system 205, and a componentof the cloud-based system 205 may perform the various imaging modulefunctions described above to detect evidence of an improper/insufficientsealing temperature and to report the detection to the surgical hub 206.According to the various aspects described above, in response to thedetected and/or identified failure event, the surgical hub 206 maydownload a program from the cloud-based system 205 for execution by thesurgical device/instrument 235 that corrects the detected issue (i.e.,program that alters surgical device/instrument parameters to preventmisfired staples, program that alters surgical device/instrumentparameters to ensure correct sealing temperature).

In some aspects, a failure event is deemed to cover a certain timeperiod, and all surgical data associated with that certain time periodcan be deemed to be associated with the failure event.

After the surgical data associated with the failure event has beenidentified, the identified surgical data (e.g., failure event surgicaldata) can be separated or isolated from all of the other surgical dataassociated with the surgical procedure (e.g., non-failure event surgicaldata). The separation can be realized, for example, by tagging orflagging the identified surgical data, by storing the identifiedsurgical data apart from all of the other surgical data associated withthe surgical procedure, or by storing only the other surgical data whilecontinuing to process the identified surgical data for subsequentprioritized communication to the cloud-based system 205. According tovarious aspects, the tagging or flagging of the identified surgical datacan occur during the communication process when the datagram isgenerated as described in more detail below.

The time-stamping of all of the surgical data (e.g., either before orafter the surgical data is received at the surgical hub) can be utilizedby a component of the surgical hub 206 to chronologize the identifiedsurgical data associated with the failure event. The component of thesurgical hub 206 which utilizes the time-stamping to chronologize theidentified surgical data can be, for example, the processor module 232,the processor 244 of the computer system 210, and/or combinationsthereof. By chronologizing the identified surgical data, the cloud-basedsystem 205 and/or other interested parties can subsequently betterunderstand the conditions which were present leading up to theoccurrence of the failure event and possibly pinpoint the exact cause ofthe failure event, thereby providing the knowledge to potentiallymitigate a similar failure event from occurring during a similarsurgical procedure performed at a future date.

Once the identified surgical data has been chronologized, thechronologized surgical data may be encrypted in a manner similar to thatdescribed above with respect to the encryption of the generator data.Thus, the identified surgical data can be encrypted to help ensure theconfidentiality of the identified surgical data, either while it isbeing stored at the surgical hub 206 or while it is being transmitted tothe cloud-based system 205 using the Internet or other computernetworks. According to various aspects, a component of the surgical hub206 utilizes an encryption algorithm to convert the identified surgicaldata from a readable version to an encoded version, thereby forming theencrypted surgical data associated with the failure event (e.g., FIGS.25-27 ). The component of the surgical hub which utilizes the encryptionalgorithm can be, for example, the processor module 232, the processor244 of the computer system 210, and/or combinations thereof. Theutilized encryption algorithm can be a symmetric encryption algorithm oran asymmetric encryption algorithm.

After the identified surgical data has been encrypted, a component ofthe surgical hub can communicate the encrypted surgical data associatedwith the failure event (e.g., encrypted failure event surgical data) tothe cloud-based system 205. The component of the surgical hub whichcommunicates the encrypted surgical data to the cloud-based system 205can be, for example, the processor module 232, a hub/switch 207/209 ofthe modular communication hub 203, the router 211 of the modularcommunication hub 203, or the communication module 247 of the computersystem 210. According to various aspects, the communication of theencrypted surgical data (e.g., encrypted failure event surgical data)through the Internet can follow an IP which: (1) defines datagrams thatencapsulate the encrypted surgical data to be delivered, and (2) definesaddressing methods that are used to label the datagram with source anddestination information. The datagram can be similar to the datagramshown in FIG. 29 or the datagram shown in FIG. 30 , but can be differentin that either the header or the payload of the datagram can include afield which includes a flag or a tag which identifies the encryptedsurgical data (e.g., encrypted failure event surgical data) as beingprioritized relative to other non-prioritized surgical data (e.g.,encrypted non-failure event surgical data). An example of such adatagram is shown in FIG. 32 , where the payload 3864 of the datagram3860 includes a field which indicates (e.g., a prioritized designation3834) that the payload 3864 includes prioritized surgical data (e.g.,combination generator data 3868). According to various aspects, thepayload 3864 of the datagram 3860 can also includenon-flagged/non-tagged/non-prioritized surgical data 3836 (e.g., othersurgical data 3874) as shown in FIG. 32 .

According to various aspects, prior to the identified surgical data(e.g., failure event surgical data) being encrypted, the identifiedsurgical data can be compressed (if not already compressed by thesource(s) of the relevant surgical data). The compression allows for asmaller representation of the surgical data associated with the failureevent to be subsequently encrypted and communicated to the cloud-basedsystem 205. For the compression, a component of the surgical hub 206 canutilize a compression algorithm to convert a representation of theidentified surgical data to a smaller representation of the identifiedsurgical data, thereby allowing for a more efficient and economicalencryption of the identified surgical data (less data to encryptutilizes less processing resources) and a more efficient and economicalcommunication of the encrypted surgical data (smaller representations ofthe surgical data within the payload of the datagrams allow for moreidentified surgical data to be included in a given datagram, for moreidentified surgical data to be communicated within a given time period,and/or for identified surgical data to be communicated with fewercommunication resources). The component of the surgical hub 206 whichutilizes the compression algorithm can be, for example, the processormodule 232, the processor 244 of the computer system 210, and/orcombinations thereof. The utilized compression algorithm can be alossless compression algorithm or a lossy compression algorithm.

In instances where other non-prioritized surgical data (e.g.,non-failure event surgical data) is to be communicated with prioritizedsurgical data (e.g., failure event surgical data), the othernon-prioritized surgical data can be time-stamped, compressed, and/orencrypted in a manner identical to or different from that describedabove regarding the surgical data identified as associated with afailure event (e.g., failure event surgical data), and the surgical hub206 may be programmed/configured to generate a datagram which includesboth the encrypted prioritized surgical data (e.g., encrypted failureevent surgical data) and the encrypted other non-prioritized surgicaldata (e.g., encrypted non-failure event surgical data). For example, inlight of FIG. 32 , the payload 3864 of the datagram 3860 may be dividedinto two or more distinct payload data portions (e.g., one for theprioritized surgical data 3834, one for the non-prioritized surgicaldata 3836), with each portion having an identifying bit (e.g., generatordata (GD) 3866, other data (OD) 3872), the associated encrypted data(e.g., encrypted prioritized surgical data 3868, encryptednon-prioritized surgical data 3874), and the associated padding 3870,3876, if needed, respectively. Further, similar to FIG. 30 , the header3862 may be the same as (e.g., IP address source 3878, IP addressdestination 3880, header length 3882) or different from the header 3782described with reference to the datagram 3780 shown in FIG. 29 . Forexample, the header 3862 may be different in that the header 3862further includes a field designating the number of payload data portions3884 (e.g., 2) included in the payload 3864 of the datagram 3860. Theheader 3862 can also be different in that it can include fieldsdesignating the payload length 3886, 3890 and the checksum value 3888,2892 for each payload data portion 3834, 3836, respectively. Althoughonly two payload data portions are shown in FIG. 32 , it will beappreciated that the payload 3864 of the datagram 3860 may include anyquantity/number of payload data portions (e.g., 1, 2, 3, 4, 5), whereeach payload data portion includes data associated with a differentaspect of the surgical procedure. The datagram 3860 can then becommunicated from the surgical hub 206 through the Internet to thecloud-based system 205 following an IP which: (1) defines datagrams thatencapsulate the encrypted generator data and the encryptedstripped/other data to be delivered, and (2) defines addressing methodsthat are used to label the datagram with source and destinationinformation.

In some aspects, once a failure event associated with a surgicalprocedure has been identified, the surgical hub 206 and/or thecloud-based system 205 can subsequently flag or tag a surgicaldevice/instrument 235 which was utilized during the surgical procedurefor inoperability and/or removal. For example, in one aspect,information (e.g., serial number, ID) associated with the surgicaldevice/instrument 235 and stored at the surgical hub 206 and/or thecloud-based system 205 can be utilized to effectively block the surgicaldevice/instrument 235 from being used again (e.g., blacklisted). Inanother aspect, information (e.g., serial number, ID) associated withthe surgical device/instrument can initiate the printing of a shippingslip and shipping instructions for returning the surgicaldevice/instrument 235 back to a manufacturer or other designated partyso that a thorough analysis/inspection of the surgical device/instrument235 can be performed (e.g., to determine the cause of the failure).According to various aspects described herein, once the cause of afailure is determined (e.g., via the surgical hub 206 and/or thecloud-based system 205), the surgical hub 206 may download a programfrom the cloud-based system 205 for execution by the surgicaldevice/instrument 235 that corrects the determined cause of the failure(i.e., program that alters surgical device/instrument parameters toprevent the failure from occurring again).

According to some aspects, the surgical hub 206 and/or the cloud-basedsystem 205 can also provide/display a reminder (e.g., via hub display215 and/or surgical device/instrument display 237) to administrators,staff, and/or other personnel to physically remove the surgicaldevice/instrument 235 from the operating room (e.g., if detected asstill present in the operating room) and/or to send the surgicaldevice/instrument 235 to the manufacturer or the other designated party.In one aspect, the reminder may be set up to be provided/displayedperiodically until an administrator can remove the flag or tag of thesurgical device/instrument 235 from the surgical hub 206 and/or thecloud-based system 205. According to various aspects, an administratormay remove the flag or tag once the administrator can confirm (e.g.,system tracking of the surgical device/instrument 235 via its serialnumber/ID) that the surgical device/instrument 235 has been received bythe manufacturer or the other designated party. By using theabove-described method to flag and/or track surgical data associatedwith a failure event, a closed loop control of the surgical dataassociated with the failure event and/or with a surgicaldevice/instrument 235 can be realized. Additionally, in view of theabove, it will be appreciated that the surgical hub 206 can be utilizedto effectively manage the utilization (or non-utilization) of surgicaldevices/instruments 235 which have or potentially could be utilizedduring a surgical procedure.

In various aspects of the present disclosure, the surgical hub 206and/or cloud-based system 205 may want to control which components(e.g., surgical device/instrument 235, energy device 241) are beingutilized in its interactive surgical system 100/200 to perform surgicalprocedures (e.g., to minimize future failure events, to avoid the use ofunauthorized or knock-off components).

As such, in various aspects of the present disclosure, since aninteractive surgical system 100 may comprise a plurality of surgicalhubs 106, a cloud-based system 105 and/or each surgical hub 106 of theinteractive surgical system 100 may want to track component-surgical hubcombinations utilized over time. In one aspect, upon/after a component(See FIG. 9 , e.g., surgical device/instrument 235, energy device 241)is connected to/used with a particular surgical hub 106 (e.g., surgicaldevice/instrument 235 wired/wirelessly connected to the particularsurgical hub 106, energy device 241 connected to the particular surgicalhub 106 via generator module 240), the particular surgical hub 106 maycommunicate a record/block of that connection/use (e.g., linkingrespective unique identifiers of the connected devices) to thecloud-based system 105 and/or to the other surgical hubs 106 in theinteractive surgical system 100. For example, upon/after theconnection/use of an energy device 241, a particular surgical hub 106may communicate a record/block (e.g., linking a unique identifier of theenergy device 241 to a unique identifier of a generator module 240 to aunique identifier of the particular surgical hub 106) to the cloud-basedsystem 105 and/or other surgical hubs 106 in the interactive surgicalsystem 100. In such an aspect, if this is the first time the component(e.g., energy device) is connected to/used with a surgical hub 106 inthe interactive surgical system 100, the cloud-based system 105 and/oreach surgical hub 106 of the interactive surgical system 100 may storethe record/block as a genesis record/block. In such an aspect, thegenesis record/block stored at the cloud-based system 105 and/or eachsurgical hub 106 may comprise a time stamp. However, in such an aspect,if this is not the first time the component (e.g., energy device 241)has been connected to/used with a surgical hub 106 in the interactivesurgical system 100, the cloud-based system 105 and/or each surgical hub106 of the interactive surgical system may store the record/block as anew record/block in a chain of record/blocks associated with thecomponent. In such an aspect, the new record/block may comprise acryptographic hash of the most recently communicated record/block storedat the cloud-based system 105 and/or each surgical hub 106, thecommunicated linkage data, and a time stamp. In such an aspect, eachcryptographic hash links each new record/block (e.g., each use of thecomponent) to its prior record/block to form a chain confirming theintegrity of each prior record/block(s) back to an original genesisrecord/block (e.g., first use of the component). According to such anaspect, this blockchain of records/blocks may be developed at thecloud-based system 105 and/or each surgical hub 106 of the interactivesurgical system 100 to permanently and verifiably tie usage of aparticular component to one or more than one surgical hub 106 in theinteractive surgical system 100 over time. Here, according to anotheraspect, this approach may be similarly applied to sub-components (e.g.,handle, shaft, end effector, cartridge) of a component when/after thecomponent is connected to/used with a particular surgical hub 106 of aninteractive surgical system 100.

According to various aspects of the present disclosure, the cloud-basedsystem 105 and/or each surgical hub 106 may utilize such records/blocksto trace usage of a particular component and/or a sub-component back toits initial usage in the interactive surgical system 100. For example,if a particular component (e.g., surgical device/instrument 235) isflagged/tagged as related to a failure event, the cloud-based system 105and/or a surgical hub 106 may analyze such records/blocks to determinewhether past usage of that component and/or a sub-component of thatcomponent contributed to or caused the failure event (e.g., overused).In one example, the cloud-based system 105 may determine that asub-component (e.g., end effector) of that component may actually becontributing/causing the failure event and then tag/flag that componentfor inoperability and/or removal based on the determination.

According to another aspect, the cloud-based system 205 and/or surgicalhub 206 may control which components (e.g., surgical device/instrument235, energy device 241) are being utilized in an interactive surgicalsystem 200 to perform surgical procedures by authenticating thecomponent and/or its supplier/manufacturer. In one aspect, thesupplier/manufacturer of a component may associate a serial number and asource ID with the component. In such an aspect, thesupplier/manufacturer may create/generate a private key for the serialnumber, encrypt the serial number with the private key, and store theencrypted serial number and the source ID on an electronic chip (e.g.,memory) in the component prior to shipment to a surgical site. Here,upon/after connection of the component to a surgical hub 206, thesurgical hub 206 may read the encrypted serial number and the source IDfrom the electronic chip. In response, the surgical hub 206 may send amessage (i.e., comprising the encrypted serial number) to a server ofthe supplier/manufacturer associated with the source ID (e.g., directlyor via the cloud-based system 205). In such an aspect, the surgical hub206 may encrypt the message using a public key associated with thatsupplier/manufacturer. In response, the surgical hub 206 may receive amessage (i.e., comprising the private key the supplier/manufacturergenerated for/associated with that encrypted serial number) from thesupplier/manufacturer server (e.g., directly or via the cloud-basedsystem 205). In such an aspect, the supplier/manufacturer server mayencrypt the message using a public key associated with the surgical hub206. Further, in such an aspect, the surgical hub 206 may then decryptthe message (e.g., using a private key paired to the public key used toencrypt the message) to reveal the private key associated with theencrypted serial number. The surgical hub 206 may then decrypt theencrypted serial number, using that private key, to reveal the serialnumber. Further, in such an aspect, the surgical hub 206 may thencompare the decrypted serial number to a comprehensive list ofauthorized serial numbers (e.g., stored at the surgical hub 206 and/orthe cloud-based system and/or downloaded from the cloud-based system,e.g., received separately from the supplier/manufacturer) and permit useof the connected component if the decrypted serial number matches anauthorized serial number. Initially, such a process permits the surgicalhub 206 to authenticate the supplier/manufacturer. In particular, thesurgical hub 206 encrypted the message comprising the encrypted serialnumber using a public key associated with the supplier/manufacturer. Assuch, receiving a response message (i.e., comprising the private key)authenticates the supplier/manufacturer to the surgical hub 206 (i.e.,otherwise the supplier/manufacturer would not have access to the privatekey paired to the public key used by the surgical hub 206 to encrypt themessage, and the supplier/manufacturer would not have been able toassociate the encrypted serial number received in the message to itsalready generated private key). Furthermore, such a process permits thesurgical hub 206 to authenticate the connected component/device itself.In particular, the supplier/manufacturer (e.g., just authenticated)encrypted the serial number of the component using the delivered privatekey. Upon secure receipt of the private key, the surgical hub 206 isable to decrypt the encrypted serial number (i.e., read from theconnected component), which authenticates the component and/or itsassociation with the supplier/manufacturer (i.e., only that private keyas received from that supplier/manufacturer would decrypt the encryptedserial number). Nonetheless, the surgical hub 206 further verifies thecomponent as authentic (e.g., compares the decrypted serial number to acomprehensive list of authorized serial numbers received separately fromthe supplier/manufacturer). Notably, such aspects as described above canalternatively be performed by the cloud-based system 205 and/or acombination of the cloud-based system 205 and the surgical hub 206 tocontrol which components (e.g., surgical device/instrument 235, energydevice 241) are being utilized in an interactive surgical system 200(e.g., to perform surgical procedures) by authenticating the componentand/or its supplier/manufacturer. In one aspect, such describedapproaches may prevent the use of knock-off component(s) within theinteractive surgical system 200 and ensure the safety and well-being ofsurgical patients.

According to another aspect, the electronic chip of a component (e.g.,surgical device/instrument 235, energy device 241) may store (e.g., inmemory) data associated with usage of that component (i.e., usage data,e.g., number of uses with a limited use device, number of usesremaining, firing algorithms executed, designation as a single-usecomponent). In such an aspect, the surgical hub 206 and/or thecloud-based system 205, upon/after connection of the component to theinteractive surgical system, may read such usage data from the memory ofa component and write back at least a portion of that usage data forstorage (e.g., in memory 249) at the surgical hub 206 and/or for storageat the cloud-based system 205 (e.g., individually and/or under ablockchain approach discussed herein). According to such an aspect, thesurgical hub 206 and/or the cloud-based system 205, upon/after asubsequent connection of that component to the interactive surgicalsystem, may again read such usage data and compare that usage topreviously stored usage data. Here, if a discrepancy exists or if apredetermined/authorized usage has been met, the surgical hub 206 and/orthe cloud-based system 205 may prevent use of that component (e.g.,blacklisted, rendered inoperable, flagged for removal) on theinteractive surgical system 200. In various aspects, such an approachprevents bypass of the encryption chip systems. If the component'selectronic chip/memory has been tampered with (e.g., memory reset,number of uses altered, firing algorithms altered, single-use devicedesignated as a multi-use device), a discrepancy will exist, and thecomponent's use will be controlled/prevented.

Additional details are disclosed in U.S. Patent Application PublicationNo. 2017/0086914, entitled TECHNIQUES FOR OPERATING GENERATOR FORDIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICALINSTRUMENTS, which published on Mar. 30, 2017, which is incorporatedherein by reference in its entirety.

Surgical Hub Coordination of Device Pairing in an Operating Room

One of the functions of the surgical hub 106 is to pair (also referredto herein as “connect” or “couple”) with other components of thesurgical system 102 to control, gather information from, or coordinateinteractions between the components of the surgical system 102. Sincethe operating rooms of a hospital are likely in close physical proximityto one another, a surgical hub 106 of a surgical system 102 mayunknowingly pair with components of a surgical system 102 in aneighboring operating room, which would significantly interfere with thefunctions of the surgical hub 106. For example, the surgical hub 106 mayunintentionally activate a surgical instrument in a different operatingroom or record information from a different ongoing surgical procedurein a neighboring operating room.

Aspects of the present disclosure present a solution, wherein a surgicalhub 106 only pairs with detected devices of the surgical system 102 thatare located within the bounds of its operating room.

Furthermore, the surgical hub 106 relies on its knowledge of thelocation of other components of the surgical system 102 within itsoperating room in making decisions about, for example, which surgicalinstruments should be paired with one another or activated. A change inthe position of the surgical hub 106 or another component of thesurgical system 102 can be problematic.

Aspects of the present disclosure further present a solution wherein thesurgical hub 106 is configured to reevaluate or redetermine the boundsof its operating room upon detecting that the surgical hub 106 has beenmoved. Aspects of the present disclosure further present a solutionwherein the surgical hub 106 is configured to redetermine the bounds ofits operating room upon detection of a potential device of the surgicalsystem 102, which can be an indication that the surgical hub 106 hasbeen moved.

In various aspects, a surgical hub 106 is used with a surgical system102 in a surgical procedure performed in an operating room. The surgicalhub 106 comprises a control circuit configured to determine the boundsof the operating room, determine devices of the surgical system 102located within the bounds of the operating room, and pair the surgicalhub 106 with the devices of the surgical system 102 located within thebounds of the operating room.

In one aspect, the control circuit is configured to determine the boundsof the operating room after activation of the surgical hub 106. In oneaspect, the surgical hub 106 includes a communication circuit configuredto detect and pair with the devices of the surgical system locatedwithin the bounds of the operating room. In one aspect, the controlcircuit is configured to redetermine the bounds of the operating roomafter a potential device of the surgical system 102 is detected. In oneaspect, the control circuit is configured to periodically determine thebounds of the operating room.

In one aspect, the surgical hub 106 comprises an operating room mappingcircuit that includes a plurality of non-contact sensors configured tomeasure the bounds of the operating room.

In various aspects, the surgical hub 106 includes a processor and amemory coupled to the processor. The memory stores instructionsexecutable by the processor to pair the surgical hub with devices of thesurgical system 102 located within the bounds of the operating room, asdescribed above. In various aspects, the present disclosure provides anon-transitory computer-readable medium storing computer-readableinstructions which, when executed, cause a machine to pair the surgicalhub 106 with devices of the surgical system 102 located within thebounds of the operating room, as described above.

FIGS. 35 and 36 are logic flow diagrams of processes depicting controlprograms or logic configurations for pairing the surgical hub 106 withdevices of the surgical system 102 located within the bounds of theoperating room, as described above.

The surgical hub 106 performs a wide range of functions that requiresshort- and long-range communication, such as assisting in a surgicalprocedure, coordinating between devices of the surgical system 102, andgathering and transmitting data to the cloud 104. To properly performits functions, the surgical hub 106 is equipped with a communicationmodule 130 capable of short-range communication with other devices ofthe surgical system 102. The communication module 130 is also capable oflong-range communication with the cloud 104.

The surgical hub 106 is also equipped with an operating-room mappingmodule 133 which is capable of identifying the bounds of an operatingroom, and identifying devices of the surgical system 102 within theoperating room. The surgical hub 106 is configured to identify thebounds of an operating room, and only pair with or connect to potentialdevices of the surgical system 102 that are detected within theoperating room.

In one aspect, the pairing comprises establishing a communication linkor pathway. In another aspect, the pairing comprises establishing acontrol link or pathway.

An initial mapping or evaluation of the bounds of the operating roomtakes place during an initial activation of the surgical hub 106.Furthermore, the surgical hub 106 is configured to maintain spatialawareness during operation by periodically mapping its operating room,which can be helpful in determining if the surgical hub 106 has beenmoved. The reevaluation 3017 can be performed periodically or it can betriggered by an event such as observing a change in the devices of thesurgical system 102 that are deemed within the operating room. In oneaspect, the change is detection 3010 of a new device that was notpreviously deemed as within the bounds of the operating room, asillustrated in FIG. 37 . In another aspect, the change is adisappearance, disconnection, or un-pairing of a paired device that waspreviously deemed as residing within the operating room, as illustratedin FIG. 38 . The surgical hub 106 may continuously monitor 3035 theconnection with paired devices to detect 3034 the disappearance,disconnection, or un-pairing of a paired device.

In other aspects, reevaluation triggering events can be, for example,changes in surgeons' positions, instrument exchanges, or sensing of anew set of tasks being performed by the surgical hub 106.

In one aspect, the evaluation of the bounds of the room by the surgicalhub 106 is accomplished by activation of a sensor array of theoperating-room mapping module 133 within the surgical hub 106 whichenables it to detect the walls of the operating room.

Other components of the surgical system 102 can be made to be spatiallyaware in the same, or a similar, manner as the surgical hub 106. Forexample, a robotic hub 122 may also be equipped with an operating-roommapping module 133.

The spatial awareness of the surgical hub 106 and its ability to map anoperating room for potential components of the surgical system 102allows the surgical hub 106 to make autonomous decisions about whetherto include or exclude such potential components as part of the surgicalsystem 102, which relieves the surgical staff from dealing with suchtasks. Furthermore, the surgical hub 106 is configured to makeinferences about, for example, the type of surgical procedure to beperformed in the operating room based on information gathered prior to,during, and/or after the performance of the surgical procedure. Examplesof gathered information include the types of devices that are broughtinto the operating room, time of introduction of such devices into theoperating room, and/or the devices sequence of activation.

In one aspect, the surgical hub 106 employs the operating-room mappingmodule 133 to determine the bounds of the surgical theater (e.g., afixed, mobile, or temporary operating room or space) using eitherultrasonic or laser non-contact measurement devices.

Referring to FIG. 34 , ultrasound based non-contact sensors 3002 can beemployed to scan the operating theater by transmitting a burst ofultrasound and receiving the echo when it bounces off a perimeter wall3006 of an operating theater to determine the size of the operatingtheater and to adjust Bluetooth pairing distance limits. In one example,the non-contact sensors 3002 can be Ping ultrasonic distance sensors, asillustrated in FIG. 34 .

FIG. 34 shows how an ultrasonic sensor 3002 sends a brief chirp with itsultrasonic speaker 3003 and makes it possible for a micro-controller3004 of the operating-room mapping module 133 to measure how long theecho takes to return to the ultrasonic sensor's ultrasonic microphone3005. The micro-controller 3004 has to send the ultrasonic sensor 3002 apulse to begin the measurement. The ultrasonic sensor 3002 then waitslong enough for the micro-controller program to start a pulse inputcommand. Then, at about the same time the ultrasonic sensor 3002 chirpsa 40 kHz tone, it sends a high signal to the micro-controller 3004. Whenthe ultrasonic sensor 3002 detects the echo with its ultrasonicmicrophone 3005, it changes that high signal back to low. Themicro-controller's pulse input command measures the time between thehigh and low changes and stores its measurement in a variable. Thisvalue can be used along with the speed of sound in air to calculate thedistance between the surgical hub 106 and the operating-room wall 3006.

In one example, as illustrated in FIG. 33 , a surgical hub 106 can beequipped with four ultrasonic sensors 3002, wherein each of the fourultrasonic sensors is configured to assess the distance between thesurgical hub 106 and a wall of the operating room 3000. A surgical hub106 can be equipped with more or less than four ultrasonic sensors 3002to determine the bounds of an operating room.

Other distance sensors can be employed by the operating-room mappingmodule 133 to determine the bounds of an operating room. In one example,the operating-room mapping module 133 can be equipped with one or morephotoelectric sensors that can be employed to assess the bounds of anoperating room. In one example, suitable laser distance sensors can alsobe employed to assess the bounds of an operating room. Laser-basednon-contact sensors may scan the operating theater by transmitting laserlight pulses, receiving laser light pulses that bounce off the perimeterwalls of the operating theater, and comparing the phase of thetransmitted pulse to the received pulse to determine the size of theoperating theater and to adjust Bluetooth pairing distance limits.

Referring to the top left corner of FIG. 33 , a surgical hub 106 isbrought into an operating room 3000. The surgical hub 106 is activatedat the beginning of the set-up that occurs prior to the surgicalprocedure. In the example of FIG. 33 , the set-up starts at an actualtime of 11:31:14 (EST) based on a real-time clock. However, at thestated procedure set-up start time, the surgical hub 106 starts 3001 anartificial randomized real-time clock timing scheme at artificial realtime 07:36:00 to protect private patient information.

At artificial real time 07:36:01, the operating-room mapping module 133employs the ultrasonic distance sensors to ultrasonically ping the room(e.g., sends out a burst of ultrasound and listens for the echo when itbounces off the perimeter walls of the operating room as describedabove) to verify the size of the operating room and to adjust pairingdistance limits.

At artificial real time 07:36:03, the data is stripped and time-stamped.At artificial real time 07:36:05, the surgical hub 106 begins pairingdevices located only within the operating room 3000 as verified usingultrasonic distance sensors 3002 of the operating-room mapping module133. The top right corner of FIG. 33 illustrates several example devicesthat are within the bounds of the operating room 3000 and are pairedwith the surgical hub 106, including a secondary display device 3020, asecondary hub 3021, a common interface device 3022, a powered stapler3023, a video tower module 3024, and a powered handheld dissector 3025.On the other hand, secondary hub 3021′, secondary display device 3020′,and powered stapler 3026 are all outside the bounds of the operatingroom 3000 and, accordingly, are not paired with the surgical hub 106.

In addition to establishing a communication link with the devices of thesurgical system 102 that are within the operating room, the surgical hub106 also assigns a unique identification and communication sequence ornumber to each of the devices. The unique sequence may include thedevice's name and a time stamp of when the communication was firstestablished. Other suitable device information may also be incorporatedinto the unique sequence of the device.

As illustrated in the top left corner of FIG. 33 , the surgical hub 106has determined that the operating room 3000 bounds are at distances a,−a, b, and −b from the surgical hub 106. Since Device “D” is outside thedetermined bounds of its operating room 3000, the surgical hub 106 willnot pair with the Device “D.” FIG. 35 is an example algorithmillustrating how the surgical hub 106 only pairs with devices within thebounds of its operating room. After activation, the surgical hub 106determines 3007 bounds of the operating room using the operating-roommapping module 133, as described above. After the initial determination,the surgical hub 106 continuously searches for or detects 3008 deviceswithin a pairing range. If a device is detected 3010, the surgical hub106 then determines 3011 whether the detected device is within thebounds of the operating room. The surgical hub 106 pairs 3012 with thedevice if it is determined that the device is within the bounds of theoperating room. In certain instances, the surgical hub 106 will alsoassign 3013 an identifier to the device. If, however, the surgical hub106 determines that the detected device is outside the bounds of theoperating room, the surgical hub 106 will ignore 3014 the device.

Referring to FIG. 36 , after an initial determination of the bounds ofthe room, and after an initial pairing of devices located within suchbounds, the surgical hub 106 continues to detect 3015 new devices thatbecome available for pairing. If a new device is detected 3016, thesurgical hub 106 is configured to reevaluate 3017 the bounds of theoperating room prior to pairing with the new device. If the new deviceis determined 3018 to be within the newly determined bounds of theoperating room, then the surgical hub 106 pairs with the device 3019 andassigns 3030 a unique identifier to the new device. If, however, thesurgical hub 106 determines that the new device is outside the newlydetermined bounds of the operating room, the surgical hub 106 willignore 3031 the device.

For pairing, the operating-room mapping module 133 contains a compassand integrated Bluetooth transceiver. Other communication mechanisms,which are not significantly affected by the hospital environment orgeographical location, can be employed. Bluetooth Low Energy (BLE)beacon technology can currently achieve indoor distance measurementswith accuracy of about 1-2 meters, with improved accuracy in closerproximities (within 0-6 meters). To improve the accuracy of the distancemeasurements, a compass is used with the BLE. The operating-room mappingmodule 133 utilizes the BLE and the compass to determine where modulesare located in relation to the patient. For example, two modules facingeach other (detected by compass) with greater than one meter distancebetween them may clearly indicate that the modules are on opposite sidesof the patient. The more “Hub”-enabled modules that reside in theoperating room, the greater the achievable accuracy becomes due totriangulation techniques.

In the situations where multiple surgical hubs 106, modules, and/orother peripherals are present in the same operating room, as illustratedin the top right corner of FIG. 33 , the operating-room mapping module133 is configured to map the physical location of each module thatresides within the operating room. This information could be used by theuser interface to display a virtual map of the room, enabling the userto more easily identify which modules are present and enabled, as wellas their current status. In one aspect, the mapping data collected bysurgical hubs 106 are uploaded to the cloud 104, where the data areanalyzed for identifying how an operating room is physically setup, forexample.

The surgical hub 106 is configured to determine a device's location byassessing transmission radio signal strength and direction. ForBluetooth protocols, the Received Signal Strength Indication (RSSI) is ameasurement of the received radio signal strength. In one aspect, thedevices of the surgical system 102 can be equipped with USB Bluetoothdongles. The surgical hub 106 may scan the USB Bluetooth beacons to getdistance information. In another aspect, multiple high-gain antennas ona Bluetooth access point with variable attenuators can produce moreaccurate results than RSSI measurements. In one aspect, the hub isconfigured to determine the location of a device by measuring the signalstrength from multiple antennas. Alternatively, in some examples, thesurgical hub 106 can be equipped with one or more motion sensor devicesconfigured to detect a change in the position of the surgical hub 106.

Referring to the bottom left corner of FIG. 33 , the surgical hub 106has been moved from its original position, which is depicted in dashedlines, to a new position closer to the device “D,” which is stilloutside the bounds of the operating room 3000. The surgical hub 106 inits new position, and based on the previously determined bounds of theoperating room, would naturally conclude that the device “D” is apotential component of the surgical system 102. However, theintroduction of a new device is a triggering event for reevaluation 3017of the bounds of the operating room, as illustrated in the examplealgorithm of FIGS. 35, 37 . After performing the reevaluation, thesurgical hub 106 determines that the operating room bounds have changed.Based on the new bounds, at distances a_(new), −a_(new), b_(new), and−b_(new), the surgical hub 106 concludes that it has been moved and thatthe Device “D” is outside the newly determined bounds of its operatingroom. Accordingly, the surgical hub 106 will still not pair with theDevice “D.”

In one aspect, one or more of the processes depicted in FIGS. 35-39 canbe executed by a control circuit of a surgical hub 106, as depicted inFIG. 10 (processor 244). In another aspect, one or more of the processesdepicted in FIGS. 35-39 can be executed by a cloud computing system 104,as depicted in FIG. 1 . In yet another aspect, one or more of theprocesses depicted in FIGS. 35-39 can be executed by at least one of theaforementioned cloud computing systems 104 and/or a control circuit of asurgical hub 106 in combination with a control circuit of a modulardevice, such as the microcontroller 461 of the surgical instrumentdepicted in FIG. 12 , the microcontroller 620 of the surgical instrumentdepicted in FIG. 16 , the control circuit 710 of the robotic surgicalinstrument 700 depicted in FIG. 17 , the control circuit 760 of thesurgical instruments 750, 790 depicted in FIGS. 18-19 , or thecontroller 838 of the generator 800 depicted in FIG. 20 .

Spatial Awareness of Surgical Hubs in Operating Rooms

During a surgical procedure, a surgical instrument such as an ultrasonicor an RF surgical instrument can be coupled to a generator module 140 ofthe surgical hub 106. In addition, a separate surgical instrumentcontroller such as a foot, or hand, switch or activation device can beused by an operator of the surgical instrument to activate the energyflow from the generator to the surgical instrument. Multiple surgicalinstrument controllers and multiple surgical instruments can be usedconcurrently in an operating room. Pressing or activating the wrongsurgical instrument controller can lead to undesirable consequences.Aspects of the present disclosure present a solution in which thesurgical hub 106 coordinates the pairing of surgical instrumentcontrollers and surgical instruments to ensure patient and operatorsafety.

Aspects of the present disclosure are presented for a surgical hub 106configured to establish and sever pairings between components of thesurgical system 102 within the bounds of the operating room tocoordinate flow of information and control actions between suchcomponents. The surgical hub 106 can be configured to establish apairing between a surgical instrument controller and a surgicalinstrument that reside within the bounds of an operating room ofsurgical hub 106.

In various aspects, the surgical hub 106 can be configured to establishand sever pairings between components of the surgical system 102 basedon operator request or situational and/or spatial awareness. The hubsituational awareness is described in greater detail below in connectionwith FIG. 86 .

Aspects of the present disclosure are presented for a surgical hub foruse with a surgical system in a surgical procedure performed in anoperating room. The surgical hub includes a control circuit thatselectively forms and severs pairings between devices of the surgicalsystem. In one aspect, the hub includes a control circuit is configuredto pair the hub with a first device of the surgical system, assign afirst identifier to the first device, pair the hub with a second deviceof the surgical system, assign a second identifier to the second device,and selectively pair the first device with the second device. In oneaspect, the surgical hub includes a storage medium, wherein the controlcircuit is configured to store a record indicative of the pairingbetween the first device and the second device in the storage medium. Inone aspect, the pairing between the first device and the second devicedefines a communication pathway therebetween. In one aspect, the pairingbetween the first device and the second device defines a control pathwayfor transmitting control actions from the second device to the firstdevice.

Further to the above, in one aspect, the control circuit is furtherconfigured to pair the hub with a third device of the surgical system,assign a third identifier to the third device, sever the pairing betweenthe first device and the second device, and selectively pair the firstdevice with the third device. In one aspect, the control circuit isfurther configured to store a record indicative of the pairing betweenthe first device and the third device in the storage medium. In oneaspect, the pairing between the first device and the third devicedefines a communication pathway therebetween. In one aspect, the pairingbetween the first device and the third device defines a control pathwayfor transmitting control actions from the third device to the firstdevice.

In various aspects, the surgical hub includes a processor and a memorycoupled to the processor. The memory stores instructions executable bythe processor to selectively form and sever pairings between the devicesof the surgical system, as described above. In various aspects, thepresent disclosure provides a non-transitory computer-readable mediumstoring computer-readable instructions which, when executed, cause amachine to selectively form and sever pairings between the devices ofthe surgical system, as described above. FIGS. 40 and 41 are logic flowdiagrams of processes depicting control programs or logic configurationsfor selectively forming and severing pairings between the devices of thesurgical system, as described above.

In one aspect, the surgical hub 106 establishes a first pairing with asurgical instrument and a second pairing with the surgical instrumentcontroller. The surgical hub 106 then links the pairings togetherallowing the surgical instrument and the surgical instrument controllerto operate with one another. In another aspect, the surgical hub 106 maysever an existing communication link between a surgical instrument and asurgical instrument controller, then link the surgical instrument toanother surgical instrument controller that is linked to the surgicalhub 106.

In one aspect, the surgical instrument controller is paired to twosources. First, the surgical instrument controller is paired to thesurgical hub 106, which includes the generator module 140, for controlof its activation. Second, the surgical instrument controller is alsopaired to a specific surgical instrument to prevent inadvertentactivation of the wrong surgical instrument.

Referring to FIGS. 40 and 42 , the surgical hub 106 may cause thecommunication module 130 to pair 3100 or establish a first communicationlink 3101 with a first device 3102 of the surgical system 102, which canbe a first surgical instrument. Then, the hub may assign 3104 a firstidentification number to the first device 3102. This is a uniqueidentification and communication sequence or number that may include thedevice's name and a time stamp of when the communication was firstestablished.

In addition, the surgical hub 106 may then cause the communicationmodule 130 to pair 3106 or establish a second communication link 3107with a second device 3108 of the surgical system 102, which can be asurgical instrument controller. The surgical hub 106 then assigns 3110 asecond identification number to the second device 3108.

In various aspects, the steps of pairing a surgical hub 106 with adevice may include detecting the presence of a new device, determiningthat the new device is within bounds of the operating room, as describedabove in greater detail, and only pairing with the new device if the newdevice is located within the bounds of the operating room.

The surgical hub 106 may then pair 3112 or authorize a communicationlink 3114 to be established between the first device 3102 and the seconddevice 3108, as illustrated in FIG. 42 . A record indicative of thecommunication link 3114 is stored by the surgical hub 106 in the storagearray 134. In one aspect, the communication link 3114 is establishedthrough the surgical hub 106. In another aspect, as illustrated in FIG.42 , the communication link 3114 is a direct link between the firstdevice 3102 and the second device 3108.

Referring to FIGS. 41 and 43 , the surgical hub 106 may then detect andpair 3120 or establish a third communication link 3124 with a thirddevice 3116 of the surgical system 102, which can be another surgicalinstrument controller, for example. The surgical hub 106 may then assign3126 a third identification number to the third device 3116.

In certain aspects, as illustrated in FIG. 43 , the surgical hub 106 maythen pair 3130 or authorize a communication link 3118 to be establishedbetween the first device 3102 and the third device 3116, while causingthe communication link 3114 to be severed 3128, as illustrated in FIG.43 . A record indicative of the formation of the communication link 3118and severing of the communication link 3114 is stored by the surgicalhub 106 in the storage array 134. In one aspect, the communication link3118 is established through the surgical hub 106. In another aspect, asillustrated in FIG. 43 , the communication link 3118 is a direct linkbetween the first device 3102 and the third device 3116.

As described above, the surgical hub 106 can manage an indirectcommunication between devices of the surgical system 102. For example,in situations where the first device 3102 is a surgical instrument andthe second device 3108 is a surgical instrument controller, an output ofthe surgical instrument controller can be transmitted through thecommunication link 3107 to the surgical hub 106, which may then transmitthe output to the surgical instrument through the communication link3101.

In making a decision to connect or sever a connection between devices ofthe surgical system 102, the surgical hub 106 may rely on perioperativedata received or generated by the surgical hub 106. Perioperative dataincludes operator input, hub-situational awareness, hub-spatialawareness, and/or cloud data. For example, a request can be transmittedto the surgical hub 106 from an operator user-interface to assign asurgical instrument controller to a surgical instrument. If the surgicalhub 106 determines that the surgical instrument controller is alreadyconnected to another surgical instrument, the surgical hub 106 may severthe connection and establish a new connection per the operator'srequest.

In certain examples, the surgical hub 106 may establish a firstcommunication link between the visualization system 108 and the primarydisplay 119 to transmit an image, or other information, from thevisualization system 108, which resides outside the sterile field, tothe primary display 119, which is located within the sterile field. Thesurgical hub 106 may then sever the first communication link andestablish a second communication link between a robotic hub 122 and theprimary display 119 to transmit another image, or other information,from the robotic hub 122 to the primary display 119, for example. Theability of the surgical hub 106 to assign and reassign the primarydisplay 119 to different components of the surgical system 102 allowsthe surgical hub 106 to manage the information flow within the operatingroom, particularly between components inside the sterile field andoutside the sterile field, without physically moving these components.

In another example that involves the hub-situational awareness, thesurgical hub 106 may selectively connect or disconnect devices of thesurgical system 102 within an operating room based on the type ofsurgical procedure being performed or based on a determination of anupcoming step of the surgical procedure that requires the devices to beconnected or disconnected. The hub situational awareness is described ingreater detail below in connection with FIG. 86 .

Referring to FIG. 44 , the surgical hub 106 may track 3140 theprogression of surgical steps in a surgical procedure and may coordinatepairing and unpairing of the devices of the surgical system 102 basedupon such progression. For example, the surgical hub 106 may determinethat a first surgical step requires use of a first surgical instrument,while a second surgical step, occurring after completion of the firstsurgical step, requires use of a second surgical instrument.Accordingly, the surgical hub 106 may assign a surgical instrumentcontroller to the first surgical instrument for the duration of thefirst surgical step. After detecting completion 3142 of the firstsurgical step, the surgical hub 106 may cause the communication linkbetween the first surgical instrument and the surgical instrumentcontroller to be severed 3144. The surgical hub 106 may then assign thesurgical instrument controller to the second surgical instrument bypairing 3146 or authorizing the establishment of a communication linkbetween the surgical instrument controller and the second surgicalinstrument.

Various other examples of the hub-situational awareness, which caninfluence the decision to connect or disconnect devices of the surgicalsystem 102, are described in greater detail below in connection withFIG. 86 .

In certain aspects, the surgical hub 106 may utilize its spatialawareness capabilities, as described in greater detail elsewhere herein,to track progression of the surgical steps of a surgical procedure andautonomously reassign a surgical instrument controller from one surgicalinstrument to another surgical instrument within the operating room ofthe surgical hub 106. In one aspect, the surgical hub 106 uses Bluetoothpairing and compass information to determine the physical position ofthe components of the surgical system 102.

In the example illustrated in FIG. 2 , the surgical hub 106 is pairedwith a first surgical instrument held by a surgical operator at theoperating table and a second surgical instrument positioned on a sidetray. A surgical instrument controller can be selectively paired witheither the first surgical instrument or the second surgical instrument.Utilizing the Bluetooth pairing and compass information, the surgicalhub 106 autonomously assigns the surgical instrument controller to thefirst surgical instrument because of its proximity to the patient.

After completion of the surgical step that involved using the firstsurgical instrument, the first surgical instrument may be returned tothe side tray or otherwise moved away from the patient. Detecting achange in the position of the first surgical instrument, the surgicalhub 106 may sever the communication link between the first surgicalinstrument and the surgical instrument controller to protect againstunintended activation of the first surgical instrument by the surgicalinstrument controller. The surgical hub 106 may also reassign thesurgical instrument controller to another surgical instrument if thesurgical hub 106 detects that it has been moved to a new position at theoperating table.

In various aspects, devices of the surgical system 102 are equipped withan easy hand-off operation mode that would allow one user to giveactivation control of a device they currently control to anothersurgical instrument controller within reach of another operator. In oneaspect, the devices are equipped to accomplish the hand-off through apredetermined activation sequence of the devices that causes the devicesthat are activated in the predetermined activation sequence to pair withone another.

In one aspect, the activation sequence is accomplished by powering onthe devices to be paired with one another in a particular order. Inanother aspect, the activation sequence is accomplished by powering onthe devices to be paired with one another within a predetermined timeperiod. In one aspect, the activation sequence is accomplished byactivating communication components, such as Bluetooth, of the devicesto be paired with one another in a particular order. In another aspect,the activation sequence is accomplished by activating communicationcomponents, such as Bluetooth, of the devices to be paired within oneanother within a predetermined time period.

Alternatively, the hand-off can also be accomplished by a selection of adevice through one of the surgical-operator input devices. After theselection is completed, the next activation by another controller wouldallow the new controller to take control.

In various aspects, the surgical hub 106 can be configured to directlyidentify components of the surgical system 102 as they are brought intoan operating room. In one aspect, the devices of the surgical system 102can be equipped with an identifier recognizable by the surgical hub 106,such as, for example, a bar code or an RFID tag. NFC can also beemployed. The surgical hub 106 can be equipped with a suitable reader orscanner for detecting the devices brought into the operating room.

The surgical hub 106 can also be configured to check and/or updatevarious control programs of the devices of the surgical system 102. Upondetecting and establishing a communication link of a device of thesurgical system 102, the surgical hub 106 may check if its controlprogram is up to date. If the surgical hub 106 determines that a laterversion of the control program is available, the surgical hub 106 maydownload the latest version from the cloud 104 and may update the deviceto the latest version. The surgical hub 106 may issue a sequentialidentification and communication number to each paired or connecteddevice.

Cooperative Utilization of Data Derived from Secondary Sources byIntelligent Surgical Hubs

In a surgical procedure, the attention of a surgical operator must befocused on the tasks at hand. Receiving information from multiplesources, such as, for example, multiple displays, although helpful, canalso be distracting. The imaging module 138 of the surgical hub 106 isconfigured to intelligently gather, analyze, organize/package, anddisseminate relevant information to the surgical operator in a mannerthat minimizes distractions.

Aspects of the present disclosure are presented for cooperativeutilization of data derived from multiple sources, such as, for example,an imaging module 138 of the surgical hub 106. In one aspect, theimaging module 138 is configured to overlay data derived from one ormore sources onto a livestream destined for the primary display 119, forexample. In one aspect, the overlaid data can be derived from one ormore frames acquired by the imaging module 138. The imaging module 138may commandeer image frames on their way for display on a local displaysuch as, for example, the primary display 119. The imaging module 138also comprises an image processor that may preform an array of localimage processing on the commandeered images.

Furthermore, a surgical procedure generally includes a number ofsurgical tasks which can be performed by one or more surgicalinstruments guided by a surgical operator or a surgical robot, forexample. Success or failure of a surgical procedure depends on thesuccess or failure of each of the surgical tasks. Without relevant dataon the individual surgical tasks, determining the reason for a failedsurgical procedure is a question of probability.

Aspects of the present disclosure are presented for capturing one ormore frames of a livestream of a surgical procedure for furtherprocessing and/or pairing with other data. The frames may be captured atthe completion of a surgical task (also referred to elsewhere herein as“surgical step”) to assess whether the surgical task was completedsuccessfully. Furthermore, the frames, and the paired data, can beuploaded to the cloud for further analysis.

In one aspect, one or more captured images are used to identify at leastone previously completed surgical task to evaluate the outcome of thesurgical task. In one aspect, the surgical task is a tissue-staplingtask. In another aspect, the surgical task is an advanced energytransection.

FIG. 45 is a logic flow diagram of a process 3210 depicting a controlprogram or a logic configuration for overlaying information derived fromone or more still frames of a livestream of a remote surgical site ontothe livestream. The process 3210 includes receiving 3212 a livestream ofa remote surgical site from a medical imaging device 124, for example,capturing 3214 at least one image frame of a surgical step of thesurgical procedure from the livestream, deriving 3216 informationrelevant to the surgical step from data extracted from the at least oneimage frame, and overlaying 3218 the information onto the livestream.

In one aspect, the still frames can be of a surgical step performed atthe remote surgical site. The still frames can be analyzed forinformation regarding completion of the surgical step. In one aspect,the surgical step comprises stapling tissue at the surgical site. Inanother aspect, the surgical task comprises applying energy to tissue atthe surgical site.

FIG. 46 is a logic flow diagram of a process 3220 depicting a controlprogram or a logic configuration for differentiating among surgicalsteps of a surgical procedure. The process 3220 includes receiving 3222a livestream of a surgical site from a medical imaging device 124, forexample, capturing 3224 at least one first image frame of a firstsurgical step of the surgical procedure from the livestream, deriving3226 information relevant to the first surgical step from data extractedfrom the at least one image frame, capturing 3228 at least one secondimage frame of a second surgical step of the surgical procedure from thelivestream, and differentiating 3229 among the first surgical step andthe second surgical step based on the at least one first image frame andthe at least one second image frame.

FIG. 47 is a logic flow diagram of a process 3230 depicting a controlprogram or a logic configuration for differentiating among surgicalsteps of a surgical procedure. The process 3232 includes receiving 3232a livestream of the surgical site from a medical imaging device 124, forexample, capturing 3234 image frames of the surgical steps of thesurgical procedure from the livestream and differentiating 3236 amongthe surgical steps based on data extracted from the image frames.

FIG. 48 is a logic flow diagram of a process 3240 depicting a controlprogram or a logic configuration for identifying a staple cartridge frominformation derived from one or more still frames of staples deployedfrom the staple cartridge into tissue. The process 3240 includesreceiving 3242 a livestream of the surgical site from medical imagingdevice 124, for example, capturing 3244 an image frame from thelivestream, detecting 3246 a staple pattern in the image frame, whereinthe staple pattern is defined by staples deployed from a staplecartridge into tissue at the surgical site. The process 3240 furtherincludes identifying 3248 the staple cartridge based on the staplepattern.

In various aspects, one or more of the steps of the processes 3210,3220, 3230, 3240 can be executed by a control circuit of an imagingmodule of a surgical hub, as depicted in FIGS. 3, 9, 10 . In certainexamples, the control circuit may include a processor and a memorycoupled to the processor, wherein the memory stores instructionsexecutable by the processor to perform one or more of the steps of theprocesses 3210, 3220, 3230, 3240. In certain examples, a non-transitorycomputer-readable medium stores computer-readable instructions which,when executed, cause a machine to perform one or more of the steps ofthe processes 3210, 3220, 3230, 3240. For economy, the followingdescription of the processes 3210, 3220, 3230, 3240 will be described asbeing executed by the control circuit of an imaging module of a surgicalhub; however, it should be understood that the execution of theprocesses 3210, 3220, 3230, 3240 can be accomplished by any of theaforementioned examples.

Referring to FIGS. 34 and 49 , a surgical hub 106 is in communicationwith a medical imaging device 124 located at a remote surgical siteduring a surgical procedure. The imaging module 138 receives alivestream of the remote surgical site transmitted by the imaging device124 to a primary display 119, for example, in accordance with steps3212, 3222, 3232, 3242.

Further to the above, the imaging module 138 of the surgical hub 106includes a frame grabber 3200. The frame grabber 3200 is configured tocapture (i.e., “grabs”) individual, digital still frames from thelivestream transmitted by the imaging device 124, for example, to aprimary display 119, for example, during a surgical procedure, inaccordance with steps 3214, 3224, 3234, 3244. The captured still framesare stored and processed by a computer platform 3203 (FIG. 49 ) of theimaging module 138 to derive information about the surgical procedure.Processing of the captured frames may include performance of simpleoperations, such as histogram calculations, 2D filtering, and arithmeticoperations on arrays of pixels to the performance of more complex tasks,such as object detection, 3D filtering, and the like.

In one aspect, the derived information can be overlaid onto thelivestream. In one aspect, the still frames and/or the informationresulting from processing the still frames can be communicated to acloud 104 for data aggregation and further analysis.

In various aspects, the frame grabber 3200 may include a digital videodecoder and a memory for storing the acquired still frames, such as, forexample, a frame buffer. The frame grabber 3200 may also include a businterface through which a processor can control the acquisition andaccess the data and a general purpose I/O for triggering imageacquisition or controlling external equipment.

As described above, the imaging device 124 can be in the form of anendoscope, including a camera and a light source positioned at a remotesurgical site, and configured to provide a livestream of the remotesurgical site at the primary display 119, for example.

In various aspects, image recognition algorithms can be implemented toidentify features or objects in still frames of a surgical site that arecaptured by the frame grabber 3200. Useful information pertaining to thesurgical steps associated with the captured frames can be derived fromthe identified features. For example, identification of staples in thecaptured frames indicates that a tissue-stapling surgical step has beenperformed at the surgical site. The type, color, arrangement, and sizeof the identified staples can also be used to derive useful informationregarding the staple cartridge and the surgical instrument employed todeploy the staples. As described above, such information can be overlaidon a livestream directed to a primary display 119 in the operating room.

The image recognition algorithms can be performed at least in partlocally by the computer platform 3203 (FIG. 49 ) of the imaging module138. In certain instances, the image recognition algorithms can beperformed at least in part by the processor module 132 of the surgicalhub 106. An image database can be utilized in performance of the imagerecognition algorithms and can be stored in a memory 3202 of thecomputer platform 3203. Alternatively, the imaging database can bestored in the storage array 134 (FIG. 3 ) of the surgical hub 106. Theimage database can be updated from the cloud 104.

An example image recognition algorithm that can be executed by thecomputer platform 3203 may include a key points-based comparison and aregion-based color comparison. The algorithm includes: receiving aninput at a processing device, such as, for example, the computerplatform 3203; the input, including data related to a still frame of aremote surgical site; performing a retrieving step, including retrievingan image from an image database and, until the image is either acceptedor rejected, designating the image as a candidate image; performing animage recognition step, including using the processing device to performan image recognition algorithm on the still frame and candidate imagesin order to obtain an image recognition algorithm output; and performinga comparison step, including: if the image recognition algorithm outputis within a pre-selected range, accepting the candidate image as thestill frame and if the image recognition algorithm output is not withinthe pre-selected range, rejecting the candidate image and repeating theretrieving, image recognition, and comparison steps.

Referring to FIGS. 50-52 , in one example, a surgical step involvesstapling and cutting tissue. FIG. 50 depicts a still frame 3250 of astapled and cut tissue T. A staple deployment 3252 includes staples3252′, 3252″ from a first staple cartridge. A second staple deployment3254 includes staples 3254′, 3254″ from a second staple cartridge. Aproximal portion 3253 of the staple deployment 3252 overlaps with adistal portion 3255 of the staple deployment 3254. Six rows of stapleswere deployed in each deployment. Tissue T was cut between the third andfourth rows of each deployment, but only one side of the stapled tissueT is fully shown.

In various aspects, the imaging module 138 identifies one or more of thestaples 3252′, 3252″, 3254′, 3254″ in the still frame 3250, which wereabsent in a previous still frame captured by the frame grabber 3200. Theimaging module 138 then concludes that a surgical stapling and cuttinginstrument has been used at the surgical site.

In the example of FIG. 50 , the staple deployment 3252 includes twodifferent staples 3252′, 3252″. Likewise, the staple deployment 3254includes two different staples 3254′, 3254″. For brevity, the followingdescription focuses on the staples 3252′, 3252″, but is equallyapplicable to the staples 3254′, 3254″. The staples 3252′, 3252″ arearranged in a predetermined pattern or sequence that forms a uniqueidentifier corresponding to the staple cartridge that housed the staples3252′, 3252″. The unique pattern can be in a single row or multiple rowsof the staples 3250. In one example, the unique pattern can be achievedby alternating the staples 3252′, 3252″ at a predetermined arrangement.

In one aspect, multiple patterns can be detected in a firing of staples.Each pattern can be associated with a unique characteristic of thestaples, the staple cartridge that housed the staples, and/or thesurgical instrument that was employed to fire the staple. For example, afiring of staples may include patterns that represent staple form,staple size, and/or location of the firing.

In the example, of FIG. 50 , the imaging module 138 may identify aunique pattern of the staples 3252 from the still frame 3250. A databasestoring staple patterns and corresponding identification numbers ofstaple cartridges can then be explored to determine an identificationnumber of a staple cartridge that housed the staples 3252.

The patterns of the example of FIG. 50 are based on only two differentstaples; however, other aspects may include three or more differentstaples. The different staples can be coated with different coatings,which can be applied to the staples by one or more of the followingmethods: anodizing, dying, electro-coating, photoluminescent coating,application of nitrides, methyl methacylate, painting, powder coating,coating with paraffins, oil stains or phosphor coatings, the use ofhydroxyapatite, polymers, titanium oxinitrides, zinc sulfides, carbides,etc. It should be noted that, while the listed coatings are fairlyspecific as disclosed herein, other coatings known in the art todistinguish the staple are within the contemplated scope of the presentdisclosure.

In the example of FIGS. 50-52 , the staples 3252′ are anodized staples,while the staples 3252″ are non-anodized staples. In one aspect, thedifferent staples may comprise two or more different colors. Differentmetal staples may comprise magnetic or radioactive staple markers thatdifferentiate them from unmarked staples.

FIG. 51 illustrates a staple deployment 3272 deployed into tissue from astaple cartridge via a surgical instrument. Only three staple rows 3272a, 3272 b, 3272 c are depicted in FIG. 51 . The rows 3272 a, 3272 b,3272 c are arranged between a medial line, where the tissue was cut, anda lateral line at the tissue edge. For clarity, the inner row 3272 a ofstaples is redrawn separately to the left and the outer two rows 3272 b,3272 c are redrawn separately to the right. A proximal end 3273 and adistal end portion of the staple deployment 3272 are also redrawn inFIG. 51 for clarity.

The staple deployment 3272 includes two different staples 3272′, 3272″that are arranged in predetermined patterns that serve variousfunctions. For example, the inner row 3272 a comprises a pattern ofalternating staples 3272′, 3272″, which defines a metric for distancemeasurements in the surgical field. In other words, the pattern of theinner row 3272 a acts as a ruler for measuring distances, which can behelpful in accurately determining the position of a leak, for example.The outer rows 3272 b, 3272 c define a pattern that represents anidentification number of the staple cartridge that housed the staples3272′, 3272″.

Furthermore, unique patterns at the ends of the staple deployment 3272identify the proximal end portion 3273 and distal end portion 3275. Inthe example of FIG. 51 , a unique arrangement of three staples 3272″identifies the distal end 3275, while a unique arrangement of fourstaples 3272″ identifies the proximal end 3273. Identification of theproximal and distal ends of a staple deployment allows the imagingmodule 128 to distinguish between different staple deployments within acaptured frame, which can be useful in pointing the source of a leak,for example.

In various aspects, the imaging module 138 may detect a sealed tissue ina still frame of a remote surgical site captured by the frame grabber3200. Detection of the sealed tissue can be indicative of a surgicalstep that involves applying therapeutic energy to tissue.

Sealing tissue can be accomplished by the application of energy, such aselectrical energy, for example, to tissue captured or clamped within anend effector of a surgical instrument in order to cause thermal effectswithin the tissue. Various mono-polar and bi-polar RF surgicalinstruments and harmonic surgical instruments have been developed forsuch purposes. In general, the delivery of energy to captured tissue canelevate the temperature of the tissue and, as a result, the energy canat least partially denature proteins within the tissue. Such proteins,like collagen, for example, can be denatured into a proteinaceousamalgam that intermixes and fuses, or seals, together as the proteinsrenature.

Accordingly, sealed tissue has a distinct color and/or shape that can bedetected by the imaging module 138 using image recognition algorithms,for example. In addition, smoke detection at the surgical site canindicate that therapeutic energy application to the tissue is inprogress.

Further to the above, the imaging module 138 of the surgical hub 106 iscapable of differentiating between surgical steps of a surgicalprocedure based on the captured frames. As described above, a stillframe that comprises fired staples is indicative of a surgical stepinvolving tissue stapling, while a still frame that comprises a sealedtissue is indicative of a surgical step involving energy application totissue.

In one aspect, the surgical hub 106 may selectively overlay informationrelevant to a previously completed surgical task onto the livestream.For example, the overlaid information may comprise image data from astill frame of the surgical site captured during the previouslycompleted surgical task. Furthermore, guided by common landmarklocations at the surgical site, the imaging module 138 can interlace oneimage frame to another to establish and detect surgical locations andrelationship data of a previously completed surgical task.

In one example, the surgical hub 106 is configured to overlayinformation regarding a potential leak in a tissue treated by staplingor application of therapeutic energy in a previously completed surgicaltask. The potential leak can be spotted by the imaging module 138 duringthe processing of a still frame of the tissue. The surgical operator canbe alerted about the leak by overlaying information about the potentialleak onto the livestream.

In various aspects, still frames of an end effector of a surgicalinstrument at a surgical site can be used to identify the surgicalinstrument. For example, the end effector may include an identificationnumber that can be recognized by the imaging module 138 during imageprocessing of the still frame. Accordingly, the still frames captured bythe imaging module 138 may be used to identify a surgical instrumentutilized in a surgical step of a surgical procedure. The still framesmay also include useful information regarding the performance of thesurgical instrument. All such information can be uploaded to the cloud104 for data aggregation and further analysis.

In various examples, the surgical hub 106 may also selectively overlayinformation relevant to a current or upcoming surgical task, such as ananatomical location or a surgical instrument suitable for the surgicaltask.

The imaging module 138 may employ various images and edge detectiontechniques to track a surgical site where a surgical instrument was usedto complete a surgical task. Success or failure of the surgical task canthen be assessed. For example, a surgical instrument can be employed toseal and/or cut tissue at the surgical site. A still frame of thesurgical site can be stored in the memory 3202 or the storage array 134of the surgical hub 106, for example, upon completion of the surgicaltask.

In the following surgical step, the quality of the seal can be testedvia different mechanisms. To ensure that the testing is accuratelyapplied to the treated tissue, the stored still frame of the surgicalsite is overlaid onto the livestream in search of a match. Once a matchis found, the testing can take place. One or more additional stillframes can be taken during the testing, which can be later analyzed bythe imaging module 138 of the surgical hub 106. The testing mechanismsinclude bubble detection, bleeding detection, dye detection (where a dyeis employed at the surgical site), and/or burst stretch detection (wherea localized strain is applied adjacent to an anastomosis site), forexample.

The imaging module 138 may capture still frames of the response of thetreated tissue to these tests, which can be stored in the memory 3202 orthe storage array 134 of the surgical hub 106, for example. The stillframes can be stored alone or in combination with other data, such as,for example, data from the surgical instrument that performed the tissuetreatment. The paired data can also be uploaded to the cloud 104 foradditional analysis and/or pairing.

In various aspects, the still frames captured by the frame grabber 3200can be processed locally, paired with other data, and can also betransmitted to the cloud 104. The size of the processed and/ortransmitted data will depend on the number of captured frames. Invarious aspects, the rate at which the frame grabber 3200 captures thestill frames from the livestream can be varied in an effort to reducethe size of the data without sacrificing quality.

In one aspect, the frame-capturing rate may depend on the type ofsurgical task being performed. Certain surgical tasks may need a highernumber of still frames than others for an evaluation of success orfailure. The frame-capturing rate can be scalded to accommodate suchneeds.

In one aspect, the frame-capturing rate is dependent upon the detectedmotion of the imaging device 124. In use, an imaging device 124 maytarget one surgical site for a period of time. Observing no or minorchanges in the still frames captured while the imaging device 124 is notbeing moved, the imaging module 138 may reduce the frame-capturing rateof the frame grabber 3200. If the situation changes, however, wherefrequent motion is detected, the imaging module 138 may respond byincreasing the frame-capturing rate of the frame grabber 3200. In otherwords, the imaging module 138 may be configured to correlate theframe-capturing rate of the frame grabber 3200 with the detected degreeof motion of the imaging device 124.

For additional efficiency, only portions of the still frames, wheremotion is detected, need to be stored, processed, and/or transmitted tothe cloud 104. The imaging module 138 can be configured to select theportions of the still frames where motion is detected. In one example,motion detection can be achieved by comparing a still frame to apreviously captured still frame. If movement is detected, the imagingmodule 138 may cause the frame grabber 3200 to increase theframe-capturing rate, but only the portions where motion is detected arestored, processed, and/or transmitted to the cloud 104.

In another aspect, the data size can be managed by scaling theresolution of the captured information based on the area of the screenwhere the focal point is or where end effectors are located, forexample. The remainder of the screen could be captured at a lowerresolution.

In one aspect, the corners of the screen and the edges could generallybe captured at a lower resolution. The resolution, however, can bescalded up if an event of significance is observed.

During a surgical procedure, the surgical hub 106 can be connected tovarious operating-room monitoring devices, such as, for example, heartrate monitors and insufflation pumps. Data collected from these devicescan improve the situational awareness of the surgical hub 106. The hubsituational awareness is described in greater detail below in connectionwith FIG. 86 .

In one example, the surgical hub 106 can be configured to utilizepatient data received from a heart rate monitor connected along withdata regarding the location of the surgical site to assess proximity ofthe surgical site to sensory nerves. An increase in the patient's heartrate, when combined with anatomical data indicating that the surgicalsite is in a region high in sensory nerves, can be construed as anindication of sensory nerve proximity. Anatomical data can be availableto the surgical hub 106 through accessing patient records (e.g., an EMRdatabase containing patient records).

The surgical hub 106 may be configured to determine the type of surgicalprocedure being performed on a patient from data received from one ormore of the operating-room monitoring devices, such as, for example,heart rate monitors and insufflation pumps. Abdominal surgicalprocedures generally require insufflation of the abdomen, whileinsufflation is not required in theoretic surgery. The surgical hub 106can be configured to determine whether a surgical procedure is anabdominal or a thoracic surgical procedure by detecting whether theinsufflation pump is active. In one aspect, the surgical hub 106 may beconfigured to monitor insufflation pressure on the output side of theinsufflation pump in order to determine whether the surgical procedurebeing performed is one that requires insufflation.

The surgical hub 106 may also gather information from other secondarydevices in the operating room to assess, for example, whether thesurgical procedure is a vascular or avascular procedure.

The surgical hub 106 may also monitor AC current supply to one or moreof its components to assess whether a component is active. In oneexample, the surgical hub 106 is configured to monitor AC current supplyto the generator module to assess whether the generator is active, whichcan be an indication that the surgical procedure being performed is onethat requires application of energy to seal tissue.

In various aspects, secondary devices in the operating room that areincapable of communication with the surgical hub 106 can be equippedwith communication interface devices (communication modules) that canfacilitate pairing of these devices with the surgical hub 106. In oneaspect, the communication interface devices may be configured to bebridging elements, which would allow them two-way communication betweenthe surgical hub 106 and such devices.

In one aspect, the surgical hub 106 can be configured to control one ormore operational parameters of a secondary device through acommunication interface device. For example, the surgical hub 106 can beconfigured to increase or decrease the insufflation pressure through acommunication interface device coupled to an insufflation device.

In one aspect, the communication interface device can be configured toengage with an interface port of the device. In another aspect, thecommunication interface device may comprise an overlay or otherinterface that directly interacts with a control panel of the secondarydevice. In other aspects, the secondary devices, such as, for example,the heart rate monitor and/or the insufflation devices, can be equippedwith integrated communication modules that allow them to pair with thehub for two-way communication therewith.

In one aspect, the surgical hub 106 can also be connected through acommunication interface device, for example, to muscle pads that areconnected to the neuro-stim detection devices to improve resolution of anerve-sensing device.

Furthermore, the surgical hub 106 can also be configured to manageoperating room supplies. Different surgical procedures require differentsupplies. For example, two different surgical procedures may requiredifferent sets of surgical instruments. Certain surgical procedures mayinvolve using a robotic system, while others may not. Furthermore, twodifferent surgical procedures may require staple cartridges that aredifferent in number, type, and/or size. Accordingly, the suppliesbrought into the operating room can provide clues as to the nature ofthe surgical procedure that will be performed.

In various aspects, the surgical hub 106 can be integrated with anoperating room supplies scanner to identify items pulled into theoperating room and introduced into the sterile field. The surgical hub106 may utilize data from the operating room supplies scanner, alongwith data from the devices of the surgical system 102 that are pairedwith the surgical hub 106, to autonomously determine the type ofsurgical procedure that will be performed. In one example, the surgicalhub 106 may record a list of serial numbers of the smart cartridge thatare going to be used in the surgical procedure. During the surgicalprocedure, the surgical hub 106 may gradually remove the staples thathave been fired, based on information collected from the staplecartridge chips. In one aspect, the surgical hub 106 is configured tomake sure that all the items are accounted for at the end of theprocedure.

Surgical Hub Control Arrangements

In a surgical procedure, a second surgical hub may be brought into anoperating room already under the control of a first surgical hub. Thesecond surgical hub can be, for example, a surgical robotic hub broughtinto the operating room as a part of a robotic system. Withoutcoordination between the first and second surgical hubs, the roboticsurgical hub will attempt to pair with all the other components of thesurgical system 102 that are within the operating room. The confusionarising from the competition between two hubs in a single operating roomcan lead to undesirable consequences. Also, sorting out the instrumentdistribution between the hubs during the surgical procedure can be timeconsuming.

Aspects of the present disclosure are presented for a surgical hub foruse with a surgical system in a surgical procedure performed in anoperating room. A control circuit of the surgical hub is configured todetermine the bounds of the operating room and establish a controlarrangement with a detected surgical hub located within the bounds ofthe operating room.

In one aspect, the control arrangement is a peer-to-peer arrangement. Inanother aspect, the control arrangement is a master-slave arrangement.In one aspect, the control circuit is configured to select one of amaster mode of operation or a slave mode of operation in themaster-slave arrangement. In one aspect, the control circuit isconfigured to surrender control of at least one surgical instrument tothe detected surgical hub in the slave mode of operation.

In one aspect, the surgical hub includes an operating room mappingcircuit that includes a plurality of non-contact sensors configured tomeasure the bounds of the operating room.

In various aspects, the surgical hub includes a processor and a memorycoupled to the processor. The memory stores instructions executable bythe processor to coordinate a control arrangement between surgical hubs,as described above. In various aspects, the present disclosure providesa non-transitory computer-readable medium storing computer-readableinstructions which, when executed, cause a machine to coordinate acontrol arrangement between surgical hubs, as described above.

Aspects of the present disclosure are presented for a surgical systemcomprising two independent surgical hubs that are configured to interactwith one another. Each of the hubs has their own linked surgical devicesand the control designation of and distribution of where data isrecorded and processed. This interaction causes one or both hubs tochange how they were behaving before the interaction. In one aspect, thechange involves a redistribution of devices previously assigned to eachof the hubs. In another aspect, the change involves establishing amaster-slave arrangement between the hubs. In yet another aspect, thechange can be a change in the location of the processing shared betweenthe hubs.

FIG. 53 is a logic flow diagram of a process depicting a control programor a logic configuration for coordinating a control arrangement betweensurgical hubs. The process of FIG. 53 is similar in many respects to theprocess of FIG. 35 except that the process of FIG. 53 addressesdetection of a surgical hub by another surgical hub. As illustrated inFIG. 53 , the surgical hub 106 determines 3007 the bounds of theoperating room. After the initial determination, the surgical hub 106continuously searches for or detects 3008 devices within a pairingrange. If a device is detected 3010, and if the detected device islocated 3011 within the bounds of the operating room, the surgical hub106 pairs 3012 with the device and assigns 3013 an identifier to thedevice. If through an initial interaction, as described below in greaterdetail, the surgical hub 106 determines 3039 that the device is anothersurgical hub, a control arrangement is established 3040 therebetween.

Referring to FIG. 54 , a robotic surgical hub 3300 enters an operatingroom already occupied by a surgical hub 3300. The robotic surgical hub3310 and the surgical hub 3300 are similar in many respects to othersurgical hubs described in greater detail elsewhere herein, such as, forexample, the surgical hubs 106. For example, the robotic surgical hub3310 includes non-contact sensors configured to measure the bounds ofthe operating room, as described in greater detail elsewhere herein inconnection with FIGS. 33, 34 .

As the robotic surgical hub 3310 is powered up, it determines the boundsof the operating room and begins to pair with other components of thesurgical system 102 that are located within the bounds of the operatingroom. The robotic surgical hub 3310 pairs with a robotic advanced energytool 3311, a robotic stapler 3312, a monopolar energy tool 3313, and arobotic visualization tower 3314, which are all located within thebounds of the operating room. The surgical hub 3300 is already pairedwith a handheld stapler 3301, a handheld powered dissector 3302, asecondary display 3303, a surgeon interface 3304, and a visualizationtower 3305. Since the handheld stapler 3301, the handheld powereddissector 3302, the secondary display 3303, the surgeon interface 3304,and the visualization tower 3305 are already paired with the surgicalhub 3300, such devices cannot pair with another surgical hub withoutpermission from the surgical hub 3300.

Further to the above, the robotic surgical hub 3310 detects and/or isdetected by the surgical hub 3300. A communication link is establishedbetween the communication modules of the surgical hubs 3300, 3310. Thesurgical hubs 3300, 3310 then determine the nature of their interactionby determining a control arrangement therebetween. In one aspect, thecontrol arrangement can be a master-slave arrangement. In anotheraspect, the control arrangement can be a peer-to-peer arrangement.

In the example of FIG. 54 , a master-slave arrangement is established.The surgical hubs 3300, 3310 request permission from a surgical operatorfor the robotic surgical hub 3310 to take control of the operating roomfrom the surgical hub 3300. The permission can be requested through asurgeon interface or console 3304. Once permission is granted, therobotic surgical hub 3310 requests the surgical hub 3300 to transfercontrol to the robotic surgical hub 3310.

Alternatively, the surgical hubs 3300, 3310 can negotiate the nature oftheir interaction without external input based on previously gathereddata. For example, the surgical hubs 3300, 3310 may collectivelydetermine that the next surgical task requires use of a robotic system.Such determination may cause the surgical hub 3300 to autonomouslysurrender control of the operating room to the robotic surgical hub3310. Upon completion of the surgical task, the robotic surgical hub3310 may then autonomously return the control of the operating room tosurgical hub 3300.

The outcome of the interaction between the surgical hubs 3300, 3310 isillustrated on the right of FIG. 54 . The surgical hub 3300 hastransferred control to the robotic surgical hub 3310, which has alsotaken control of the surgeon interface 3304 and the secondary display3303 from the surgical hub 3300. The robotic surgical hub 3310 assignsnew identification numbers to the newly transferred devices. Thesurgical hub 3300 retains control the handheld stapler 3301, thehandheld powered dissector 3302, and visualization tower 3305. Inaddition, the surgical hub 3300 performs a supporting role, wherein theprocessing and storage capabilities of the surgical hub 3300 are nowavailable to the robotic surgical hub 3310.

FIG. 55 is a logic flow diagram of a process depicting a control programor a logic configuration for coordinating a control arrangement betweensurgical hubs. In various aspects, two independent surgical hubs willinteract with one another in a predetermined manner to assess the natureof their relationship. In one example, after establishing 3321 acommunication link, the surgical hubs exchange 3322 data packets. A datapacket may include type, identification number, and/or status of asurgical hub. A data packet may further include a record of devicesunder control of the surgical hub and/or any limited communicationconnections, such as data ports for other secondary operating roomdevices.

The control arrangement between the surgical hubs is then determined3323 based on input from a surgical operator or autonomously between thesurgical hubs. The surgical hubs may store instructions as to how todetermine a control arrangement therebetween. The control arrangementbetween two surgical hubs may depend on the type of surgical procedurebeing performed. The control arrangement between two surgical hubs maydepend on their types, identification information, and/or status. Thecontrol arrangement between two surgical hubs may depend on the devicespaired with the surgical hubs. The surgical hubs then redistribute 3324the devices of the surgical system 102 therebetween based upon thedetermined control arrangement.

In the master-slave arrangement, the record communication can beunidirectional from the slave hub to the master hub. The master hub mayalso require the slave hub to hand-off some of its wireless devices toconsolidate communication pathways. In one aspect, the slave hub can berelegated to a relay configuration with the master hub originating allcommands and recording all data. The slave hub can remain linked to themaster hub for a distributed sub-processing of the master hub commands,records, and/or controls. Such interaction expands the processingcapacity of the dual linked hubs beyond the capabilities of the masterhub by itself.

In a peer-to-peer arrangement, each surgical hub may retain control ofits devices. In one aspect, the surgical hubs may cooperate incontrolling a surgical instrument. In one aspect, an operator of thesurgical instrument may designate the surgical hub that will control thesurgical instrument at the time of its use.

Referring generally to FIGS. 56-61 , the interaction between surgicalhubs can be extended beyond the bounds of the operating room. In variousaspects, surgical hubs in separate operating rooms may interact with oneanother within predefined limits. Depending on their relative proximity,surgical hubs in separate operating rooms may interact through anysuitable wired or wireless data communication network such as Bluetoothand WiFi. As used here, a “data communication network” represents anynumber of physical, virtual, or logical components, including hardware,software, firmware, and/or processing logic configured to support datacommunication between an originating component and a destinationcomponent, where data communication is carried out in accordance withone or more designated communication protocols over one or moredesignated communication media.

In various aspects, a first surgical operator in a first operating roommay wish to consult a second surgical operator in a second operatingroom, such as in case of an emergency. A temporary communication linkmay be established between the surgical hubs of the first and secondoperating room to facilitate the consult while the first and secondsurgical operators remain in their respective operating rooms.

The surgical operator being consulted can be presented with a consultrequest through the surgical hub in his/her operating room. If thesurgical operator accepts, he/she will have access to all the datacompiled by the surgical hub requesting the consult. The surgicaloperator may access all previously stored data, including a full historyof the procedure. In addition, a livestream of the surgical site at therequesting operating room can be transmitted through the surgical hubsto a display at the receiving operating room.

When a consult request begins, the receiving surgical hub begins torecord all received information in a temporarily storage location, whichcan be a dedicated portion of the storage array of the surgical hub. Atthe end of the consult, the temporary storage location is purged fromall the information. In one aspect, during a consult, the surgical hubrecords all accessible data, including blood pressure, ventilation data,oxygen stats, generator settings and uses, and all patient electronicdata. The recorded data will likely be more than the data stored by thesurgical hub during normal operation, which is helpful in providing thesurgical operator being consulted with as much information as possiblefor the consult.

Referring to FIG. 56 , a non-limiting example of an interaction betweensurgical hubs in different operating rooms is depicted. FIG. 56 depictsan operating room OR 1 that includes a surgical system 3400 supporting athoracic segmentectomy and a second operating room OR 3 that includes asurgical system 3410 supporting a colorectal procedure. The surgicalsystem 3400 includes surgical hub 3401, surgical hub 3402, and roboticsurgical hub 3403. The surgical system 3400 further includes a personalinterface 3406, a primary display 3408, and secondary displays 3404,3405. The surgical system 3410 includes a surgical hub 3411 and asecondary display 3412. For clarity, several components of the surgicalsystems 3400, 3410 are removed.

In the example of FIG. 56 , the surgical operator of OR 3 is requestinga consult from the surgical operator of OR 1. A surgical hub 3411 of theOR 3 transmits the consult request to one of the surgical hubs of the OR1, such as the surgical hub 3401. In OR 1, the surgical hub 3401presents the request at a personal interface 3406 held by the surgicaloperator. The consult is regarding selecting an optimal location of acolon transection. The surgical operator of OR 1, through a personalinterface 3406, recommends an optimal location for the transection sitethat avoids a highly vascular section of the colon. The recommendationis transmitted in real time through the surgical hubs 3401, 3411.Accordingly, the surgical operator is able to respond to the consultrequest in real time without having to leave the sterile field of hisown operating room. The surgical operator requesting the consult alsodid not have to leave the sterile field of OR 3.

If the surgical hub 3401 is not in communication with the personalinterface 3406, it may relay the message to another surgical hub suchas, for example, the surgical hub 3402 or the robotic surgical hub 3403.Alternatively, the surgical hub 3401 may request control of the personalinterface 3406 from another surgical hub.

In any event, if the surgical operator of OR 1 decides to accept theconsult request, a livestream, or frames, of a surgical site 3413 of thecolorectal procedure of OR 3 is transmitted to OR 1 through a connectionestablished between the surgical hubs 3401, 3411, for example. FIG. 57illustrates a livestream of the surgical site 3413 displayed on asecondary display of OR 3. The surgical hubs 3401, 3411 cooperate totransmit the livestream of the surgical site of OR 3 to the personalinterface 3406 of the OR 1, as illustrated in FIG. 58 .

Referring to FIGS. 59-61 , the surgical operator may expand thelaparoscopic livestream from OR 3 onto the primary display 3405 in OR 1,for example, through the controls of the personal interface 3406. Thepersonal interface 3406 allows the surgical operator to select adestination for the livestream by presenting the surgical operator withicons that represent the displays that are available in OR 1, asillustrated in FIG. 60 . Other navigation controls 3407 are available tothe surgical operator through the personal interface 3406, asillustrated in FIG. 61 . For example, the personal interface 3406includes navigation controls for adjusting the livestream of thesurgical site of OR 3 in OR 1 by the surgical operator moving his or herfingers on the livestream displayed on the personal interface 3406. Tovisualize the high vasculature regions, the consulted surgical operatormay change the view of the livestream from OR 3 through the personalinterface 3406 to an advanced imaging screen. The surgical operator maythen manipulate the image in multiple planes to see the vascularizationusing a wide-angle multi-spectral view, for example.

As illustrated in FIG. 61 , the surgical operator also has access to anarray of relevant information 3420, such as, for example, heart rate,blood pressure, ventilation data, oxygen stats, generator settings anduses, and all patient electronic data of the patient in OR 3.

Data Management and Collection

In one aspect the surgical hub provides data storage capabilities. Thedata storage includes creation and use of self-describing data includingidentification features, management of redundant data sets, and storageof the data in a manner of paired data sets which can be grouped bysurgery but not necessarily keyed to actual surgical dates and surgeonsto maintain data anonymity. The following description incorporates byreference all of the “hub” and “cloud” analytics system hardware andsoftware processing techniques to implement the specific data managementand collection techniques described hereinbelow, as incorporated byreference herein. FIGS. 62-80 will be described in the context of theinteractive surgical system 100 environment including a surgical hub106, 206 described in connection FIGS. 1-11 and intelligent instrumentsand generators described in connection with FIGS. 12-21 .

Electronic Medical Record (EMR) Interaction

FIG. 62 is a diagram 4000 illustrating a technique for interacting witha patient Electronic Medical Record (EMR) database 4002, according toone aspect of the present disclosure. In one aspect, the presentdisclosure provides a method of embedding a key 4004 within the EMRdatabase 4002 located within the hospital or medical facility. A databarrier 4006 is provided to preserve patient data privacy and allows thereintegration of stripped and isolated data pairs, as describedhereinbelow, from the surgical hub 106, 206 or the cloud 104, 204, to bereassembled. A schematic diagram of the surgical hub 206 is describedgenerally in FIGS. 1-11 and in particular in FIGS. 9-10 . Therefore, inthe description of FIG. 62 , the reader is guided to FIG. 1-11 and inparticular FIGS. 9-10 for any implementation details of the surgical hub206 that may be omitted here for conciseness and clarity of disclosure.Returning to FIG. 62 , the method allows the users full access to allthe data collected during a surgical procedure and patient informationstored in the form of electronic medical records 4012. The reassembleddata can be displayed on a monitor 4010 coupled to the surgical hub 206or secondary monitors but is not permanently stored on any surgical hubstorage device 248. The reassembled data is temporarily stored in astorage device 248 located either in the surgical hub 206 or the cloud204 and is deleted at the end of its use and overwritten to insure itcannot be recovered. The key 4004 in the EMR database 4002 is used toreintegrate anonymized hub data back into full integrated patientelectronic medical records 4012 data.

As shown in FIG. 62 , the EMR database 4002 is located within thehospital data barrier 4006. The EMR database 4002 may be configured forstoring, retrieving, and managing associative arrays, or other datastructures known today as a dictionary or hash. Dictionaries contain acollection of objects, or records, which in turn have many differentfields within them, each containing data. The patient electronic medicalrecords 4012 may be stored and retrieved using a key 4004 that uniquelyidentifies the patient electronic medical record 4012, and is used toquickly find the data within the EMR database 4002. The key-value EMRdatabase 4002 system treats the data as a single opaque collection whichmay have different fields for every record.

Information from the EMR database 4002 may be transmitted to thesurgical hub 206 and the patient electronic medical records 4012 data isredacted and stripped before it is sent to an analytics system basedeither on the hub 206 or the cloud 204. An anonymous data file 4016 iscreated by redacting personal patient data and stripping relevantpatient data 4018 from the patient electronic medical record 4012. Asused herein, the redaction process includes deleting or removingpersonal patient information from the patient electronic medical record4012 to create a redacted record that includes only anonymous patientdata. A redacted record is a record from which sensitive patientinformation has been expunged. Un-redacted data may be deleted 4019. Therelevant patient data 4018 may be referred to herein asstripped/extracted data 4018. The relevant patient data 4018 is used bythe surgical hub 206 or cloud 204 processing engines for analyticpurposes and may be stored on the storage device 248 of the surgical hub206 or may be stored on the cloud 204 based analytics system storagedevice 205. The surgical hub anonymous data file 4016 can be rebuiltusing a key 4004 stored in the EMR database 4002 to reintegrate thesurgical hub anonymous data file 4016 back into a fully integratedpatient electronic medical record 4012. The relevant patient data 4018that is used in analytic processes may include information such as thepatient's diagnoses of emphysema, pre-operative treatment (e.g.,chemotherapy, radiation, blood thinner, blood pressure medication,etc.), typical blood pressures, or any data that alone cannot be used toascertain the identity of the patient. Data 4020 to be redacted includespersonal information removed from the patient electronic medical record4012, may include age, employer, body mass index (BMI), or any data thatcan be used to ascertain the identify of the patient. The surgical hub206 creates a unique anonymous procedure ID number (e.g., 380i4z), forexample, as described in FIG. 63 . Within the EMR database 4002 locatedin the hospital data barrier 4006, the surgical hub 206 can reunite thedata in the anonymous data file 4016 stored on the surgical hub 206storage device 248 with the data in the patient electronic medicalrecord 4012 stored on the EMR database 4002 for surgeon review. Thesurgical hub 206 displays the combined patient electronic medical record4012 on a display or monitor 4010 coupled to the surgical hub 206.Ultimately, un-redacted data is deleted 4019 from the surgical hub 206storage 248.

Creation of a Hospital Data Barrier, Inside which the Data from Hubs Canbe Compared Using Non-Anonymized Data and Outside of which the Data Hasto be Stripped

In one aspect, the present disclosure provides a surgical hub 206 asdescribed in FIGS. 9 and 10 , for example, where the surgical hub 206comprises a processor 244; and a memory 249 coupled to the processor244. The memory 249 stores instructions executable by the processor 244to interrogate a surgical instrument 235, retrieve a first data set fromthe surgical instrument 235, interrogate a medical imaging device 238,retrieve a second data set from the medical imaging device 238,associate the first and second data sets by a key, and transmit theassociated first and second data sets to a remote network, e.g., thecloud 204, outside of the surgical hub 206. The surgical instrument 235is a first source of patient data and the first data set is associatedwith a surgical procedure. The medical imaging device 238 is a secondsource of patient data and the second data set is associated with anoutcome of the surgical procedure. The first and second data records areuniquely identified by the key.

In another aspect, the surgical hub 206 provides a memory 249 storinginstructions executable by the processor 244 to retrieve the first dataset using the key, anonymize the first data set, retrieve the seconddata set using the key, anonymize the second data set, pair theanonymized first and second data sets, and determine success rate ofsurgical procedures grouped by the surgical procedure based on theanonymized paired first and second data sets.

In another aspect, the surgical hub 206 provides a memory 249 storinginstructions executable by the processor 244 to retrieve the anonymizedfirst data set, retrieve the anonymized second data set, and reintegratethe anonymized first and second data sets using the key.

In another aspect, the first and second data sets define first andsecond data payloads in respective first and second data packets.

In various aspects, the present disclosure provides a control circuit toassociate the first and second data sets by a key as described above. Invarious aspects, the present disclosure provides a non-transitorycomputer readable medium storing computer readable instructions which,when executed, causes a machine to associate the first and second datasets by a key as described above.

During a surgical procedure it would be desirable to monitor dataassociated with the surgical procedure to enable configuration andoperation of instruments used during the procedure to improve surgicaloutcomes. The technical challenge is to retrieve the data in a mannerthat maintains the anonymity of the patient to maintain privacy of thedata associated with the patient. The data may be used forconglomeration with other data without individualizing the data.

One solution provides a surgical hub 206 to interrogate an electronicmedical records database 4002 for patient electronic medical records4012 data, strip out desirable or relevant patient data 4018 from thepatient electronic medical record 4012, and redact any personalinformation that could be used to identify the patient. The redactiontechnique removes any information that could be used to correlate thestripped relevant patient data 4018 to a specific patient, surgery, ortime. The surgical hub 206 and the instruments 235 coupled to thesurgical hub 206 can then be configured and operated based on thestripped relevant patient data 4018.

As disclosed in connection with FIG. 62 , extracting (or stripping)relevant patient data 4018 from a patient electronic medical record 4012while redacting any information that can be used to correlate thepatient with the surgery or a scheduled time of the surgery enables therelevant patient data 4018 to be anonymized. The anonymous data file4016 can then be sent to the cloud 204 for aggregation, processing, andmanipulation. The anonymous data file 4016 can be used to configure thesurgical instrument 235, or any of the modules shown in FIGS. 9 and 10or the surgical hub 206 during the surgery based on the extractedanonymous data file 4016.

In one aspect, a hospital data barrier 4006 is created such that insidethe data barrier 4006 data from various surgical hubs 206 can becompared using non-anonymized un-redacted data and outside the databarrier 4006 data from various surgical hubs 206 are stripped tomaintain anonymity and protect the privacy of the patient and thesurgeon. This aspect is discussed further in connection with FIG. 66 .

In one aspect, the data from a surgical hub 206 can be exchanged betweensurgical hubs 206 (e.g., hub-to-hub, switch-to-switch, orrouter-to-router) to provide in-hospital analysis and display of thedata. FIG. 1 shows an example of multiple hubs 106 in communicationwhich each other and with the cloud 104. This aspect also is discussedfurther in connection with FIG. 66 .

In another aspect, an artificial time measure is substituted for a realtime clock for all information stored internally within an instrument235, a robot located in a robot hub 222, a surgical hub 206, and/orhospital computer equipment. The anonymized data, which may includeanonymized patient and surgeon data, is transmitted to the server 213 inthe cloud 204 and it is stored in the cloud storage device 205 coupledto the server 213. The substitution of an artificial real time clockenables anonymizing the patient data and surgeon data while maintainingdata continuity. In one aspect, the instrument 235, robot hub 222,surgical hub 206, and/or the cloud 204 are configured to obscure patientidentification (ID) while maintaining data continuity. This aspect isdiscussed further in connection with FIG. 63 .

Within the surgical hub 206, a local decipher key 4004 allowsinformation retrieved from the surgical hub 206 itself to reinstate thereal-time information from the anonymized data set located in theanonymous data file 4016. The data stored on the hub 206 or the cloud204, however, cannot be reinstated to real-time information from theanonymized data set in the anonymous data file 4016. The key 4004 isheld locally in the surgical hub 206 computer/storage device 248 in anencrypted format. The surgical hub 206 network processor ID is part ofthe decryption mechanism such that if the key 4004 and data is removed,the anonymized data set in the anonymous data file 4016 cannot berestored without being on the original surgical hub 206 computer/storagedevice 248.

Substituting Artificial Time Measure for Real Time Clock for AllInternally Stored Information and Sent to the Cloud as a Means toAnonymizing the Patient and Surgeon Data

FIG. 63 illustrates a process 4030 of anonymizing a surgical procedureby substituting an artificial time measure for a real time clock for allinformation stored internally within the instrument, robot, surgicalhub, and/or hospital computer equipment, according to one aspect of thepresent disclosure. As shown in FIG. 63 , the surgical procedure set-upstart time 4032 was scheduled to begin at an actual time of 11:31:14(EST) based on a real time clock. At the stated procedure set-up starttime 4032, the surgical hub 206 starts 4034 an artificial randomizedreal time clock timing scheme at artificial real time at 07:36:00. Thesurgical hub 206 then ultrasonically pings 4036 the operating theater(e.g., sends out a burst of ultrasound and listens for the echo when itbounces off the perimeter walls of an operating theater (e.g., a fixed,mobile, temporary, or field the operating room) as described inconnection with FIG. 64 to verify the size of the operating theater andto adjust short range wireless, e.g., Bluetooth, pairing distance limitsat artificial real time 07:36:01. At artificial real time 07:36:03, thesurgical hub 206 strips 4038 the relevant data and applies a time stampto the stripped data. At artificial real time 07:36:05, the surgical hub206 wakes up and begins pairing 4040 only devices located within theoperating theater as verified using the ultrasonic pinging 4036 process.

FIG. 64 illustrates ultrasonic pinging of an operating room wall todetermine a distance between a surgical hub and the operating room wall,in accordance with at least one aspect of the present disclosure. Withreference also to FIG. 2 , the spatial awareness of the surgical hub 206and its ability to map an operating room for potential components of thesurgical system allows the surgical hub 206 to make autonomous decisionsabout whether to include or exclude such potential components as part ofthe surgical system, which relieves the surgical staff from dealing withsuch tasks. Furthermore, the surgical hub 206 is configured to makeinferences about, for example, the type of surgical procedure to beperformed in the operating room based on information gathered prior to,during, and/or after the performance of the surgical procedure. Examplesof gathered information include the types of devices that are broughtinto the operating room, time of introduction of such devices into theoperating room, and/or the devices sequence of activation.

In one aspect, the surgical hub 206 employs the operating-room mappingmodule, such as, for example, the non-contact sensor module 242 todetermine the bounds of the surgical theater (e.g., a fixed, mobile, ortemporary operating room or space) using either ultrasonic or lasernon-contact measurement devices.

Referring now to FIG. 64 , ultrasound based non-contact sensors 3002 canbe employed to scan the operating theater by transmitting a burst ofultrasound and receiving the echo when it bounces off a perimeter wall3006 of an operating theater to determine the size of the operatingtheater and to adjust short range wireless, e.g., Bluetooth, pairingdistance limits. In one example, the non-contact sensors 3002 can bePing ultrasonic distance sensors, as illustrated in FIG. 64 .

FIG. 64 shows how an ultrasonic sensor 3002 sends a brief chirp with itsultrasonic speaker 3003 and makes it possible for a micro-controller3004 of the operating-room mapping module to measure how long the echotakes to return to the ultrasonic sensor's ultrasonic microphone 3005.The micro-controller 3004 has to send the ultrasonic sensor 3002 a pulseto begin the measurement. The ultrasonic sensor 3002 then waits longenough for the micro-controller program to start a pulse input command.Then, at about the same time the ultrasonic sensor 3002 chirps a 40 kHztone, it sends a high signal to the micro-controller 3004. When theultrasonic sensor 3002 detects the echo with its ultrasonic microphone3005, it changes that high signal back to low. The micro-controller'spulse input command measures the time between the high and low changes,and stores it measurement in a variable. This value can be used alongwith the speed of sound in air to calculate the distance between thesurgical hub 106 and the operating-room wall 3006.

In one example, a surgical hub 206 can be equipped with four ultrasonicsensors 3002, wherein each of the four ultrasonic sensors is configuredto assess the distance between the surgical hub 206 and a wall of theoperating room 3000. A surgical hub 206 can be equipped with more orless than four ultrasonic sensors 3002 to determine the bounds of anoperating room.

Other distance sensors can be employed by the operating-room mappingmodule to determine the bounds of an operating room. In one example, theoperating-room mapping module can be equipped with one or morephotoelectric sensors that can be employed to assess the bounds of anoperating room. In one example, suitable laser distance sensors can alsobe employed to assess the bounds of an operating room. Laser basednon-contact sensors may scan the operating theater by transmitting laserlight pulses, receiving laser light pulses that bounce off the perimeterwalls of the operating theater, and comparing the phase of thetransmitted pulse to the received pulse to determine the size of theoperating theater and to adjust short range wireless, e.g., Bluetooth,pairing distance limits.

Stripping Out Data from Images and Connected Smart Instrument Data toAllow Conglomeration but Not Individualization

In one aspect, the present disclosure provides a data stripping methodwhich interrogates the electronic patient records provided, extracts therelevant portions to configure and operate the surgical hub andinstruments coupled to the surgical hub, while anonymizing the surgery,patient, and all identifying parameters to maintain patient privacy.

With reference now back to FIG. 63 and also to FIGS. 1-11 to showinteraction with an interactive surgical system 100 environmentincluding a surgical hub 106, 206, once the size of the operatingtheater has been verified and Bluetooth pairing is complete, based onartificial real time, the computer processor 244 of the surgical hub 206begins stripping 4038 data received from the modules coupled to thesurgical hub 206. In one example, the processor 244 begins stripping4083 images received from the imaging module 238 and connected smartinstruments 235, for example. Stripping 4038 the data allowsconglomeration of the data but not individualization of the data. Thisenables stripping 4038 the data identifier, linking the data, andmonitoring an event while maintaining patient privacy by anonymizing thedata.

With reference to FIGS. 1-64 , in one aspect, a data stripping 4038method is provided. In accordance with the data stripping 4038 method,the surgical hub 206 processor 244 interrogates the patient recordsstored in the surgical hub database 238 and extracts the relevantportions of the patient records to configure and operate the surgicalhub 206 and its instruments 235, robots, and other modular devices,e.g., modules. The data stripping 4038 method anonymizes the surgicalprocedure, patient, and all identifying parameters associated with thesurgical procedure. Stripping 4038 the data on the fly ensures that atno time the data is correlated to a specific patient, surgicalprocedure, surgeon, time or other possible identifier that can be usedto correlate the data.

The data may be stripped 4038 for compilation of the base information ata remote cloud 204 database storage device 205 coupled to the remoteserver 213. The data stored in the database storage device 248 can beused in advanced cloud based analytics, as described in U.S. ProvisionalPatent Application Ser. No. 62/611,340, filed Dec. 28, 2017, entitledCLOUD-BASED MEDICAL ANALYTICS, which is incorporated herein by referencein its entirety. A copy of the information with data links intact alsocan be stored into the patient EMR database 4002 (FIG. 62 ). Forexample, the surgical hub 206 may import patient tissue irregularitiesor co-morbidities to add to an existing data set stored in the database248. The data may be stripped 4038 before the surgery and/or may bestripped 4038 as the data is transmitted to the cloud 204 databasestorage device 205 coupled to the remote server 213.

With continued reference to FIGS. 1-11 and 62-64 , FIG. 65 is a diagram4050 depicting the process of importing patient electronic medicalrecords 4012 containing surgical procedure and relevant patient data4018 stored in the EMR database 4002, stripping 4038 the relevantpatient data 4018 from the imported medical records 4012, andidentifying 4060 smart device implications 4062, or inferences,according to one aspect of the present disclosure. As shown in FIG. 65 ,the patient electronic medical records 4012, containing informationstored in the patient EMR database 4002, are retrieved from the EMRdatabase 4002, imported into the surgical hub 206, and stored in thesurgical hub 206 storage device 248. Un-redacted data is removed ordeleted 4019 from the patient electronic medical records 4012 beforethey are stored in the surgical hub 206 storage device 248 as ananonymous data file 4016 (FIG. 62 ). The relevant patient data 4018 isthen stripped 4038 from the medical records 4012 to remove the desiredrelevant patient data 4018 and delete 4019 un-redacted data to maintainpatient anonymity. In the illustrated example, the stripped data 4058includes emphysema, high blood pressure, small lung cancer,warfarin/blood thinner, and/or radiation pretreatment. The stripped data4058 is employed to identify 4060 smart device implications whilemaintaining patient anonymity as described hereinbelow.

Although the surgical procedure data and relevant patient data 4018 isdescribed as being imported from patient electronic medical records 4012stored in the EMR database 4002, in various aspects, the surgicalprocedure data and relevant patient data 4018 may be retrieved from amodular device coupled to the surgical hub 206 before being stored inthe EMR database 4002. For example, the surgical hub 206 may interrogatethe module to retrieve the surgical procedure data and relevant patientdata 4018 from the module. As described herein, a module includes animaging module 238 that is coupled to an endoscope 239, a generatormodule 240 that is coupled to an energy device 241, a smoke evacuatormodule 226, a suction/irrigation module 228, a communication module 230,a processor module 232, a storage array 234, a smart device/instrument235 optionally coupled to a display 237, and a non-contact sensor module242, among other modules as illustrated in FIGS. 3 and 8-10 .

For example, the anonymized stripped data 4058 may be employed toidentify 4060 catastrophic failures of instruments, and other smartdevices, and may initiate an automatic archive process and submission ofdata for further implications analysis. For example, the implication ofdetecting a counterfeit component or adapter on an original equipmentmanufacturer (OEM) device would be to initiate documentation of thecomponent and recording of the results and outcome of its use. Forexample, the surgical hub 206 may execute situational awarenessalgorithms as described in connection FIG. 86 . In one aspect, thesurgical hub 206 may initially receive or identify a variety ofimplications 4062 that are derived from anonymized stripped data 4058.The surgical hub 206 is configured to control the instruments 235, orother modules, so that they operate correspondingly to the derivedimplications 4062. In one example, the surgical hub 206 control logicidentifies that (i) lung tissue may be more fragile than normal (e.g.,due to emphysema), (ii) hemostasis issues are more likely (e.g., due tohigh blood pressure and/or the patient being on a blood thinner, such aswarfarin), (iii) cancer may be more aggressive (e.g., due to the targetof the procedure being a small cell lung cancer), and (iv) lung tissuemay be stiffer and more prone to fracture (e.g., due to the patienthaving received a radiation pretreatment). The control logic orprocessor 244 of the surgical hub 206 then interprets how this dataimpacts the instruments 235, or other modules, so that the instruments235 are operated consistently with the data and then communicates thecorresponding adjustments to each of the instruments 235.

In one example relating to a stapler type of surgical instrument 235,based on the implications 4062 identified 4060 from the anonymizedstripped data 4058, the control logic or processor 244 of the surgicalhub 206 may (i) notify the stapler to adjust the compression ratethreshold parameter, (ii) adjust the surgical hub 206 visualizationthreshold value to quantify the bleeding and internal parameters, (iii)notify the combo generator module 240 of the lung tissue and vesseltissue types so that the power and generator module 240 controlalgorithms are adjusted accordingly, (iv) notify the imaging module 238of the aggressive cancer tag to adjust the margin ranges accordingly,(v) notify the stapler of the margin parameter adjustment needed (themargin parameter corresponds to the distance or amount of tissue aroundthe cancer that will be excised), and (vi) notify the stapler that thetissue is potentially fragile. Furthermore, the anonymized stripped data4058, upon which the implications 40602 are based, is identified by thesurgical hub 206 and is fed into the situational awareness algorithm(see FIG. 86 ). Examples include, without limitations, thoracic lungresection, e.g., segmentectomy, among others.

FIG. 66 is a diagram 4070 illustrating the application of cloud basedanalytics to un-redacted data, stripped relevant patient data 4018, andindependent data pairs, according to one aspect of the presentdisclosure. As shown, multiple surgical hubs Hub #1 4072, Hub #3 4074,and Hub #4 4076 are located within the hospital data barrier 4006 (seealso FIG. 62 ). The un-redacted patient electronic medical record 4012including patient data and surgery related data may be used andexchanged between the surgical hubs: Hub #1 4072, Hub #3 4074, and Hub#4 4076 located within the hospital data barrier 4006. Prior totransmitting the un-redacted patient electronic medical record 4012containing patient data and surgery related data outside the hospitaldata barrier 4006, however, the patient electronic medical record 4012patient data is redacted and stripped to create an anonymous data file4016 containing anonymized information for further analysis andprocessing of the redacted/stripped data by a cloud based analyticprocesses in the cloud 204.

FIG. 67 is a logic flow diagram 4080 of a process depicting a controlprogram or a logic configuration for associating patient data sets fromfirst and second sources of data, according to one aspect of the presentdisclosure. With reference to FIG. 67 and with reference also to FIGS.1-11 to show interaction with an interactive surgical system 100environment including a surgical hub 106, 206, in one aspect, thepresent disclosure provides a surgical hub 206, comprising a processor244; and a memory 249 coupled to the processor 244. The memory 249stores instructions executable by the processor 244 to interrogate 4082a surgical instrument 235, retrieve 4084 a first data set from thesurgical instrument 235, interrogate 4086 a medical imaging device 238,retrieve 4088 a second data set from the medical imaging device 238,associate 4090 the first and second data sets by a key, and transmit theassociated first and second data sets to a remote network outside of thesurgical hub 206. The surgical instrument 235 is a first source ofpatient data and the first data set is associated with a surgicalprocedure. The medical imaging device 238 is a second source of patientdata and the second data set is associated with an outcome of thesurgical procedure. The first and second data records are uniquelyidentified by the key.

In another aspect, the surgical hub 206 provides a memory 249 storinginstructions executable by the processor 244 to retrieve the first dataset using the key, anonymize the first data set, retrieve the seconddata set using the key, anonymize the second data set, pair theanonymized first and second data sets, and determine success rate ofsurgical procedures grouped by the surgical procedure based on theanonymized paired first and second data sets.

In another aspect, the surgical hub 206 provides a memory 249 storinginstructions executable by the processor 244 to retrieve the anonymizedfirst data set, retrieve the anonymized second data set, and reintegratethe anonymized first and second data sets using the key.

FIG. 68 is a logic flow diagram of a process 4400 depicting a controlprogram or a logic configuration for stripping data to extract relevantportions of the data to configure and operate the surgical hub 206 andmodules (e.g., instruments 235) coupled to the surgical hub 206,according to one aspect of the present disclosure. With reference toFIG. 68 and with reference also to FIGS. 1-11 to show interaction withan interactive surgical system 100 environment including a surgical hub106, 206, in one aspect, the surgical hub 206 may be configured tointerrogate a module coupled to surgical hub 206 for data, and strip thedata to extract relevant portions of the data to configure and operatethe surgical hub 206 and modules (e.g., instruments 235) coupled to thesurgical hub 206 and anonymize the surgery, patient, and otherparameters that can be used to identify the patient to maintain patientprivacy. According to the process 4400, in one aspect the presentdisclosure provides a surgical hub 206 including a processor 244, amodular communication hub 203 coupled to the processor 244, where themodular communication hub 203 is configured to connect modular deviceslocated in one or more operating theaters to the surgical hub 206. Theprocessor 244 is coupled to a memory 249, where the memory 249 storesinstructions executable by the processor 244 to cause the processor tointerrogate 4402 a modular device coupled to the processor 244 via themodular communication hub 203. The modular device is a source of datasets that include patient identity data and surgical procedure data. Theprocessor 244 receives 4404 a data set from the modular device. Theprocessor 244 discards 4406 the patient identity data and any portion ofthe surgical procedure data that identifies the patient from the dataset. The processor 244 extracts 4408 anonymous data from the data setand creates 4410 an anonymized data set. The processor 244 configures4412 the operation of the surgical hub 206 or the modular device basedon the anonymized data set.

In another aspect, where the anonymized data set includes catastrophicfailure of a modular device, the memory 249 stores instructionsexecutable by the processor 244 to initiate automatic archiving andsubmission of data for implications analysis based on the catastrophicfailure of the modular device. In another aspect, the memory 249 storesinstructions executable by the processor 244 to detect counterfeitcomponent information from the anonymized data set. In another aspect,the memory 249 stores instructions executable by the processor 244 toderive implications of the modular device from the anonymized data setand the memory 249 stores instructions executable by the processor 244to configure the modular device to operate based on the derivedimplications or to configure the surgical hub based on the derivedimplications. In another aspect, the memory 249 stores instructionsexecutable by the processor 244 to conglomerate the anonymized data. Inanother aspect, the memory 249 stores instructions executable by theprocessor 244 to extract the anonymized data prior to storing thereceived data in a storage device coupled to the surgical hub. Inanother aspect, the memory 249 stores instructions executable by theprocessor to transmit the anonymized data to a remote network outside ofthe surgical hub, compile the anonymized data at the remote network, andstore a copy of the data set from the modular device in a patientelectronic medical records database.

Storage of Data Creation and Use of Self-Describing Data IncludingIdentification Features

In one aspect, the present disclosure provides self-describing datapackets generated at the issuing instrument and including identifiersfor all devices that handled the packet. The self description allows theprocessor to interpret the data in the self-describing packet withoutknowing the data type in advance prior to receipt of the self-describingpacket. The data applies to every data point or data string and includesthe type of data, the source of the self-describing packet, the deviceidentification that generated the packet, the units, the time ofgeneration of the packet, and an authentication that the data containedin the packet is unaltered. When the processor (in the device or thesurgical hub) receives an unexpected packet and verifies the source ofthe packet, the processor alters the collection techniques to be readyfor any subsequent packets from that source.

With reference also to FIGS. 1-11 to show interaction with aninteractive surgical system 100 environment including a surgical hub106, 206, during a surgical procedure being performed in a surgical hub206 environment, the size and quantity of data being generated bysurgical devices 235 coupled to the surgical hub 206 can become quitelarge. Also, data exchanged between the surgical devices 235 and/or thesurgical hub 206 can become quite large.

One solution provides a techniques for minimizing the size of the dataand handling the data within a surgical hub 206 by generating aself-describing packet. The self-describing packet is initiallyassembled by the instrument 235 that generated it. The packet is thenordered and encrypted b generating an encryption certificate which isunique for each data packet. The data is then communicated from theinstrument 235 via encrypted wired or wireless protocols and stored onthe surgical hub 206 for processing and transmission to the cloud 204analytics engine. Each self-describing data packet includes anidentifier to identify the specific instrument that generated it and thetime it was generated. A surgical hub 206 identifier is added to thepacket when the packet is received by the surgical hub 206.

In one aspect, the present disclosure provides a surgical hub 206comprising a processor 244 and a memory 249 coupled to the processor244. The memory 249 storing instructions executable by the processor 244to receive a first data packet from a first source, receive a seconddata packet from a second source, associate the first and second datapackets, and generate a third data packet comprising the first andsecond data payloads. The first data packet comprises a first preamble,a first data payload, a source of the first data payload, and a firstencryption certificate. The first preamble defines the first datapayload and the first encryption certificate verifies the authenticityof the first data packet. The second data packet comprises a secondpreamble, a second data payload, a source of the second data payload,and a second encryption certificate. The second preamble defines thesecond data payload and the second encryption certificate verifies theauthenticity of the second data packet.

In another aspect, the memory 249 stores instructions executable by theprocessor 244 to determine that a data payload is from a new source,verify the new source of the data payload, and alter a data collectionprocess at the surgical hub to receive subsequent data packets from thenew source.

In another aspect, the memory 249 stores instructions executable by theprocessor 244 to associate the first and second data packets based on akey. In another aspect, the memory 249 stores instructions executable bythe processor 244 to anonymize the data payload of the third datapacket. In another aspect, the memory 249 stores instructions executableby the processor 244 to receive an anonymized third data packet andreintegrate the anonymized third data packet into the first and seconddata packets using the key.

In various aspects, the present disclosure provides a control circuit toreceive and process data packets as described above. In various aspects,the present disclosure provides a non-transitory computer-readablemedium storing computer readable instructions, which when executed,causes a machine to receive and process data packets as described above.

In other aspects, the present disclosure a method of generating a datapacket comprising self-describing data. In one aspect, a surgicalinstrument includes a processor and a memory coupled to the processor, acontrol circuit, and/or a computer-readable medium configured togenerate a data packet comprising a preamble, a data payload, a sourceof the data payload, and an encryption certificate. The preamble definesthe data payload and the encryption certificate verifies theauthenticity of the data packet. In various aspects, the data packet maybe generated by any module coupled to the surgical hub. Self-describingdata packets minimize data size and data handing in the surgical hub.

In one aspect, the present disclosure provides a self-describing datapacket generated at an issuing device (e.g., instrument, tool, robot).The self-describing data packet comprises identifiers for all devicesthat handle the data packet along a communication path; a selfdescription to enable a processor to interpret that data contained inthe data packet without having been told in advance of receipt of thedata packet along a path; data for every data point or data string; andtype of data, source of data, device IDs that generated the data, unitsof the data, time of generation, and authentication that the data packetis unaltered. In another aspect, when a processor receives a data packetfrom an unexpected source and verifies the source of the data, theprocessor alters the data collection technique to prepare for anysubsequent data packets from the source.

In the creation and use of a data packet comprising self-describingdata, the surgical hub includes identification features. The hub andintelligent devices use self-describing data packets to minimize datasize and data handling. In a surgical hub that generates large volumesof data, the self-describing data packets minimize data size and datahandling, thus saving time and enabling the operating theater to runmore efficiently.

FIG. 69 illustrates a self-describing data packet 4100 comprisingself-describing data, according to one aspect of the present disclosure.With reference also to FIGS. 1-11 to show interaction with aninteractive surgical system 100 environment including a surgical hub106, 206, in one aspect, self-describing data packets 4100 as shown inFIG. 69 are generated at an issuing instrument 235, or device or modulelocated in or in communication with the operating theater, and includeidentifiers for all devices 235 that handle the packet along acommunication path. The self description allows a processor 244 tointerpret the data payload of the packet 4100 without having advanceknowledge of the definition of the data payload prior to receiving theself-describing data packet 4100. The processor 244 can interpret thedata payload by parsing an incoming self-describing packet 4100 as it isreceived and identifying the data payload without being notified inadvance that the self-describing packet 4100 was received. The data isfor every data point or data string. The data payload includes type ofdata, source of data, device IDs that generated the data, data units,time when data was generated, and an authentication that theself-describing data packet 4100 is unaltered. Once the processor 244,which may be located either in the device or the surgical hub 206,receives an unexpected self-describing data packet 4100 and verifies thesource of the self-describing data packet 4100, the processor 244 altersthe data collection means to be ready for any subsequent self-describingdata packets 4100 from that source. In one example, the informationcontained in a self-describing packet 4100 may be recorded during thefirst firing 4172 in the lung tumor resection surgical proceduredescribed in connection with FIGS. 71-75 .

The self-describing data packet 4100 includes not only the data but apreamble which defines what the data is and where the data came from aswell as an encryption certificate verifying the authenticity of eachdata packet 4100. As shown in FIG. 69 , the data packet 4100 maycomprise a self-describing data header 4102 (e.g., force-to-fire [FTF],force-to-close [FTC], energy amplitude, energy frequency, energy pulsewidth, speed of firing, and the like), a device ID 4104 (e.g., 002), ashaft ID 4106 (e.g., W30), a cartridge ID 4108 (e.g., ESN736), a uniquetime stamp 4110 (e.g., 09:35:15), a force-to-fire value 4112 (e.g., 85)when the self-describing data header 4102 includes FTF (force-to-fire),otherwise, this position in the data packet 4100 includes the value offorce-to-close, energy amplitude, energy frequency, energy pulse width,speed of firing, and the like. The data packet 4100, further includestissue thickness value 4114 (e.g., 1.1 mm), and an identificationcertificate of data value 4116 (e.g., 01101010001001) that is unique foreach data packet 4100. Once the self-describing data packet 4100 isreceived by another instrument 235, surgical hub 206, cloud 204, etc.,the receiver parses the self-describing data header 4102 and based onits value knows what data type is contained in the self-describing datapacket 4100. TABLE 1 below lists the value of the self-describing dataheader 4102 and the corresponding data value.

TABLE 1 Self-Describing Data Header (4102) Data Type FTF Force To Fire(N) FTC Force To Close (N) EA Energy Amplitude (J) EF Energy Frequency(Hz) EPW Energy Pulse Width (Sec) SOF Speed Of Firing (mm/sec)

Each self-describing data packet 4100 comprising self-describing data isinitially assembled by the instrument 235, device, or module thatgenerated the self-describing data packet 4100. Subsequently, theself-describing data packet 4100 comprising self-describing data isordered and encrypted to generate an encryption certificate. Theencryption certificate is unique for each self-describing data packet4100. That data is then communicated via encrypted wired or wirelessprotocols and stored on the surgical hub 206 for processing andtransmission to the cloud 204 analytics engine.

Each self-describing data packet 4100 comprising self-describing dataincludes a device ID 4104 to identify the specific instrument 235 thatgenerated the self-describing data packet 4100, a time stamp 4110 toindicate the time that the data packet 4100 was generated, and when theself-describing data packet 4100 is received by the surgical hub 206.The surgical hub 206 ID also may be added to the self-describing datapacket 4100.

Each of the self-describing data packets 4100 comprising self-describingdata may include a packet wrapper that defines the beginning of the datapacket 4100 and the end of the data packet 4100 including anyidentifiers necessary to forecast the number and order of the bits inthe self-describing data packet.

The surgical hub 206 also manages redundant data sets. As the device 235functions and interconnects with other surgical hubs 206, multiple setsof the same data may be created and stored on various devices 235.Accordingly, the surgical hub 206 manages multiple images of redundantdata as well as anonymization and security of data. The surgical hub 206also provides temporary visualization and communication, incidentmanagement, peer-to-peer processing or distributed processing, andstorage backup and protection of data.

FIG. 70 is a logic flow diagram 4120 of a process depicting a controlprogram or a logic configuration for using data packets comprisingself-describing data, according to one aspect of the present disclosure.With reference to FIGS. 1-69 , in one aspect, the present disclosureprovides a surgical hub 206 comprising a processor 244 and a memory 249coupled to the processor 244. The memory 249 storing instructionsexecutable by the processor 244 to receive a first data packet from afirst source, receive a second data packet from a second source,associate the first and second data packets, and generate a third datapacket comprising the first and second data payloads. The first datapacket comprises a first preamble, a first data payload, a source of thefirst data payload, and a first encryption certificate. The firstpreamble defines the first data payload and the first encryptioncertificate verifies the authenticity of the first data packet. Thesecond data packet comprises a second preamble, a second data payload, asource of the second data payload, and a second encryption certificate.The second preamble defines the second data payload and the secondencryption certificate verifies the authenticity of the second datapacket.

In another aspect, the memory 249 stores instructions executable by theprocessor 244 to determine that a data payload is from a new source,verify the new source of the data payload, and alter a data collectionprocess at the surgical hub to receive subsequent data packets from thenew source.

In another aspect, the memory 249 stores instructions executable by theprocessor 244 to associate the first and second data packets based on akey. In another aspect, the memory 249 stores instructions executable bythe processor 244 to anonymize the data payload of the third datapacket. In another aspect, the memory 244 stores instructions executableby the processor 244 to receive an anonymized third data packet andreintegrate the anonymized third data packet into the first and seconddata packets using the key.

FIG. 71 is a logic flow diagram 4130 of a process depicting a controlprogram or a logic configuration for using data packets comprisingself-describing data, according to one aspect of the present disclosure.With reference to FIG. 71 and with reference also to FIGS. 1-11 to showinteraction with an interactive surgical system 100 environmentincluding a surgical hub 106, 206, in one aspect, the present disclosureprovides a surgical hub 206 comprising a processor 244 and a memory 249coupled to the processor 244. The memory 249 storing instructionsexecutable by the processor 244 to receive 4132 a first self-describingdata packet from a first data source, the first self-describing datapacket comprising a first preamble, a first data payload, a source ofthe first data payload, and a first encryption certificate. The firstpreamble defines the first data payload and the first encryptioncertificate verifies the authenticity of the first data packet. Thememory 249 storing instructions executable by the processor 244 to parse4134 the received first preamble and interpret 4136 the first datapayload based on the first preamble.

In various aspects, the memory 249 stores instructions executable by theprocessor 244 to receive a second self-describing data packet from asecond data source, the second self-describing data packet comprising asecond preamble, a second data payload, a source of the second datapayload, and a second encryption certificate. The second preambledefines the second data payload and the second encryption certificateverifies the authenticity of the second data packet. The memory 249storing instructions executable by the processor 244 to parse thereceived second preamble, interpret the second data payload based on thesecond preamble, associate the first and second self-describing datapackets, and generate a third self-describing data packet comprising thefirst and second data payloads. In one aspect, the memory storesinstructions executable by the processor to anonymize the data payloadof the third self-describing data packet.

In various aspects, the memory stores instructions executable by theprocessor to determine that a data payload was generated by a new datasource, verify the new data source of the data payload, and alter a datacollection process at the surgical hub to receive subsequent datapackets from the new data source. In one aspect, the memory storesinstructions executable by the processor to associate the first andsecond self-describing data packets based on a key. In another aspect,the memory stores instructions executable by the processor to receive ananonymized third self-describing data packet and reintegrate theanonymized third self-describing data packet into the first and secondself-describing data packets using the key.

Storage of the Data in a Manner of Paired Data Sets which Can be Groupedby Surgery but Not Necessarily Keyed to Actual Surgical Dates andSurgeons

In one aspect, the present disclosure provides a data pairing methodthat allows a surgical hub to interconnect a device measured parameterwith a surgical outcome. The data pair includes all the relevantsurgical data or patient qualifiers without any patient identifier data.The data pair is generated at two separate and distinct times. Thedisclosure further provides configuring and storing the data in such amanner as to be able to rebuild a chronological series of events ormerely a series of coupled but unconstrained data sets. The disclosurefurther provides storing data in an encrypted form and having predefinedbackup and mirroring to the cloud.

To determine the success or failure of a surgical procedure, data storedin a surgical instrument should be correlated with the outcome of thesurgical procedure while simultaneously anonymizing the data to protectthe privacy of the patient. One solution is to pair data associated witha surgical procedure, as recorded by the surgical instrument during thesurgical procedure, with data assessing the efficacy of the procedure.The data is paired without identifiers associated with surgery, patient,or time to preserve anonymity. The paired data is generated at twoseparate and distinct times.

In one aspect, the present disclosure provides a surgical hub configuredto communicate with a surgical instrument. The surgical hub comprises aprocessor and a memory coupled to the processor. The memory storinginstructions executable by the processor to receive a first data setassociated with a surgical procedure, receive a second data setassociated with the efficacy of the surgical procedure, anonymize thefirst and second data sets by removing information that identifies apatient, a surgery, or a scheduled time of the surgery, and store thefirst and second anonymized data sets to generate a data pair grouped bysurgery. The first data set is generated at a first time, the seconddata set is generated at a second time, and the second time is separateand distinct from the first time.

In another aspect, the memory stores instructions executable by theprocessor to reconstruct a series of chronological events based on thedata pair. In another aspect, the memory stores instructions executableby the processor to reconstruct a series of coupled but unconstraineddata sets based on the data pair. In another aspect, the memory storesinstructions executable by the processor to encrypt the data pair,define a backup format for the data pair, and mirror the data pair to acloud storage device.

In various aspects, the present disclosure provides a control circuit toreceive and process data sets as described above. In various aspects,the present disclosure provides a non-transitory computer-readablemedium storing computer readable instructions, which when executed,causes a machine to receive and process data sets as described above.

Storage of paired anonymous data enables the hospital or surgeon to usethe data pairs locally to link to specific surgeries or to store thedata pairs to analyze overall trends without extracting specific eventsin chronological manner.

In one aspect, the surgical hub provides user defined storage andconfiguration of data. Storage of the data may be made in a manner ofpaired data sets which can be grouped by surgery, but not necessarilykeyed to actual surgical dates and surgeons. This technique providesdata anonymity with regard to the patient and surgeon.

In one aspect, the present disclosure provides a data pairing method.The data pairing method comprises enabling a surgical hub tointerconnect a device measured parameter with an outcome, wherein a datapair includes all the relevant tissue or patient qualifiers without anyof the identifiers, wherein the data pair is generated at two distinctand separate times. In another aspect, the present disclosure provides adata configuration that includes whether the data is stored in such amanner as to enable rebuilding a chronological series of events ormerely a series of coupled but unconstrained data sets. In anotheraspect, the data may be stored in an encrypted form. The stored data maycomprise a predefined backup and mirroring to the cloud.

The data may be encrypted locally to the device. The data backup may beautomatic to an integrated load secondary storage device. The deviceand/or the surgical hub may be configured to maintain the time ofstorage of the data and compile and transmit the data to anotherlocation for storage, e.g., another surgical hub or a cloud storagedevice. The data may be grouped together and keyed for transmission tothe cloud analytics location. A cloud based analytics system isdescribed in commonly-owned U.S. Provisional Patent Application Ser. No.62/611,340, filed Dec. 28, 2017, entitled CLOUD-BASED MEDICAL ANALYTICS,which is incorporated herein by reference in its entirety.

In another aspect, the hub provides user selectable options for storingthe data. In one technique, the hub enables the hospital or the surgeonto select if the data should be stored in such a manner that it could beused locally in a surgical hub to link to specific surgeries. In anothertechnique, the surgical hub enables the data to be stored as data pairsso that overall trends can be analyzed without specific events extractedin a chronological manner.

FIG. 72 is a diagram 4150 of a tumor 4152 embedded in the right superiorposterior lobe 4154 of the right lung 4156, according to one aspect ofthe present disclosure. To remove the tumor 4152, the surgeon cutsaround the tumor 4152 along the perimeter generally designated as amargin 4158. A fissure 4160 separates the upper lobe 4162 and the middlelobe 4164 of the right lung 4156. In order to cut out the tumor 4152about the margin 4158, the surgeon must cut the bronchial vessels 4166leading to and from the middle lobe 4164 and the upper lobe 4162 of theright lung 4156. The bronchial vessels 4166 must be sealed and cut usinga device such as a surgical stapler, electrosurgical instrument,ultrasonic instrument, a combo electrosurgical/ultrasonic instrument,and/or a combo stapler/electrosurgical device generally representedherein as the instrument/device 235 coupled to the surgical hub 206. Thedevice 235 is configured to record data as described above, which isformed as a data packet, encrypted, stored, and/or transmitted to aremote data storage device 105 and processed by the server 113 in thecloud 104. FIGS. 77 and 78 are diagrams that illustrate the right lung4156 and the bronchial tree 4250 embedded within the parenchyma tissueof the lung.

In one aspect, the data packet may be in the form of the self-describingdata 4100 described in connection with FIGS. 69-71 . The self-describingdata packet 4100 will contain the information recorded by the device 235during the procedure. Such information may include, for example, aself-describing data header 4102 (e.g., force-to-fire [FTF],force-to-close [FTC], energy amplitude, energy frequency, energy pulsewidth, speed of firing, and the like) based on the particular variable.The device ID 4104 (e.g., 002) of the instrument/device 235 used in theprocedure including components of the instrument/device 235 such as theshaft ID 4106 (e.g., W30) and the cartridge ID 4108 (e.g., ESN736). Theself-describing packet 4100 also records a unique time stamp 4110 (e.g.,09:35:15) and procedural variables such as a force-to-fire value 4112(e.g., 85) when the self-describing data header 4102 includes FTF(force-to-fire), otherwise, this position in the data packet 4100includes the value of force-to-close (FTC), energy amplitude, energyfrequency, energy pulse width, speed of firing, and the like, as shownin TABLE 1, for example. The data packet 4100, further may includetissue thickness value 4114 (e.g., 1.1mm), which in this example refersto the thickness of the bronchial vessel 4166 exposed in the fissure4160 that were sealed and cut. Finally, each self-describing packet 4100includes an identification certificate of data value 4116 (e.g.,01101010001001) that uniquely identifies each data packet 4100transmitted by the device/instrument 235 to the surgical hub 206,further transmitted from the surgical hub 206 to the cloud 204 andstored on the storage device 205 coupled to the server 213, and/orfurther transmitted to the robot hub 222 and stored.

The data transmitted by way of a self-describing data packet 4100 issampled by the instrument device 235 at a predetermined sample rate.Each sample is formed into a self-describing data packet 4100 which istransmitted to the surgical hub 206 and eventually is transmitted fromthe surgical hub 206 to the cloud 204. The samples may be stored locallyin the instrument device 235 prior to packetizing or may be transmittedon the fly. The predetermined sampling rate and transmission rate aredictated by communication traffic in the surgical hub 206 and may beadjusted dynamically to accommodate current bandwidth limitations.Accordingly, in one aspect, the instrument device 235 may record all thesamples taken during surgery and at the end of the procedure packetizeeach sample into a self-describing packet 4100 and transmit theself-describing packet 4100 to the surgical hub 206. In another aspect,the sampled data may be packetized as it is recorded and transmitted tothe surgical hub 206 on the fly.

FIG. 73 is a diagram 4170 of a lung tumor resection surgical procedureincluding four separate firings of a surgical stapler device 235 to sealand cut bronchial vessels 4166 exposed in the fissure 4160 leading toand from the upper and lower lobes 4162, 4164 of the right lung 4156shown in FIG. 72 , according to one aspect of the present disclosure.The surgical stapler device 235 is identified by a Device ID “002”. Thedata from each firing of the surgical stapler device 235 is recorded andformed into a data packet 4100 comprising self-describing data as shownin FIG. 70 . The self-describing data packet 4100 shown in FIG. 70 isrepresentative of the first firing of device “002” having a staplecartridge serial number of ESN736, for example. In the followingdescription, reference also is made to FIGS. 12-19 for descriptions ofvarious architectures of instruments/devices 235 that include aprocessor or a control circuit coupled to a memory for recording (e.g.,saving or storing) data collected during a surgical procedure.

The first firing 4172 is recorded at anonymous time 09:35:15. The firstfiring 4172 seals and severs a first bronchial vessel 4166 leading toand from the middle lobe 4164 and the upper lobe 4162 of the right lung4156 into a first portion 4166 a and a second portion 4166 b, where eachportion 4166 a, 4166 b is sealed by respective first and second staplelines 4180 a, 4180 b. Information associated with the first firing 4172,for example the information described in connection with FIG. 70 , isrecorded in the surgical stapler device 235 memory and is used to builda first self-describing data packet 4100 described in connection withFIGS. 69-71 . The first self-describing packet 4100 may be transmittedupon completion of the first firing 4172 or may be kept stored in thesurgical stapler device 235 memory until the surgical procedure iscompleted. Once transmitted by the surgical stapler device 235, thefirst self-describing data packet 4100 is received by the surgical hub206. The first self-describing data packet 4100 is anonymized bystripping and time stamping 4038 the data, as discussed, for example, inconnection with FIG. 63 . After the lung resection surgical iscompleted, the integrity of the seals of the first and second staplelines 4182 a, 4182 b will be evaluated as shown in FIG. 74 , forexample, and the results of the evaluation will be paired withinformation associated with the first firing 4172.

The second firing 4174 seals and severs a second bronchial vessel of thebronchial vessels 4166 leading to and from the middle lobe 4164 and theupper lobe 4162 of the right lung 4156 into a first portion 4166 c and asecond portion 4166 d, where each portion 4166 c, 4166 d is sealed byfirst and second staple lines 4180 c, 4180 d. Information associatedwith the second firing 4174, for example the information described inconnection with FIGS. 69-71 , is recorded in the surgical stapler device235 memory and is used to build a second self-describing data packet4100 described in connection with FIGS. 69-71 . The secondself-describing data packet 4100 may be transmitted upon completion ofthe second firing 4174 or may be kept stored in the surgical staplerdevice 235 memory until the surgical procedure is completed. Oncetransmitted by the surgical stapler device 235, the secondself-describing data packet 4100 is received by the surgical hub 206.The second self-describing data packet 4100 is anonymized by strippingand time stamping 4038 the data as discussed, for example, in connectionwith FIG. 63 . After the lung resection surgical is completed, theintegrity of the seals of the first and second staple lines 4182 c, 4182d will be evaluated as shown in FIG. 74 , for example, and the resultsof the evaluation will be paired with information associated with thesecond firing 4174.

The third firing 4176 is recorded at anonymous time 09:42:12. The thirdfiring 4176 seals and severs an outer portion of the upper and middlelobes 4162, 4164 of the right lung 4156. First and second staple lines4182 a, 4182 b are used to seal the outer portion of the upper andmiddle lobes 4162, 4162. Information associated with the third firing4176, for example the information described in connection with FIGS.69-71 , is recorded in the surgical stapler device 235 memory and isused to build a third self-describing data packet 4100 described inconnection with FIGS. 69-71 . The third self-describing packet 4100 maybe transmitted upon completion of the third firing 4176 or may be keptstored in the surgical stapler device 235 memory until the surgicalprocedure is completed. Once transmitted by the surgical stapler device235, the third self-describing data packet 4100 is received by thesurgical hub 206. The third self-describing data packet 4100 isanonymized by stripping and time stamping 4038 the data, as discussed,for example, in connection with FIG. 63 . After the lung resectionsurgical is completed, the integrity of the seals of the first andsecond staple lines 4180 a, 4180 b will be evaluated as shown in FIG. 74, for example, and the results of the evaluation will be paired withinformation associated with the third firing 4172.

The fourth firing 4178 seals and severs an inner portion of the upperand middle lobes 4162, 4162 of the right lung 4156. First and secondstaple lines 4182 c, 4182 d are used to seal the inner portions of theupper and middle lobes 4162, 4164. Information associated with thefourth firing 4178, for example the information described in connectionwith FIG. 70 , is recorded in the surgical stapler device 235 memory andis used to build a fourth self-describing data packet 4100 described inconnection with FIGS. 69-71 . The fourth self-describing packet 4100 maybe transmitted upon completion of the fourth firing 4178 or may be keptstored in the surgical stapler device 235 memory until the surgicalprocedure is completed. Once transmitted by the surgical stapler device235, the fourth self-describing data packet 4100 is received by thesurgical hub 206. The fourth self-describing data packet 4100 isanonymized by stripping and time stamping 4038 the data, as discussed,for example, in connection with FIG. 63 . After the lung resectionsurgical is completed, the integrity of the seals of the first andsecond staple lines 4182 a, 4182 b will be evaluated as shown in FIG. 74, for example, and the results of the evaluation will be paired withinformation associated with the fourth firing 4172.

FIG. 74 is a graphical illustration 4190 of a force-to-close (FTC)versus time curve 4192 and a force-to-fire (FTF) versus time curve 4194characterizing the first firing 4172 of device 002 shown in FIG. 73 ,according to one aspect of the present disclosure. The surgical staplerdevice 235 is identified as 002 with a 30 mm staple cartridge S/N ESN736with a PVS shaft S/N M3615N (Shaft ID W30). The surgical stapler device235 was used for the first firing 4172 to complete the lung resectionsurgical procedure shown in FIG. 73 . As shown in FIG. 74 , the peakforce-to-fire force of 85 N. is recorded at anonymous time 09:35:15.Algorithms in the surgical stapler device 235 determine a tissuethickness of about 1.1 mm. As described hereinbelow, the FTC versus timecurve 4192 and the FTF versus time curve 4194 characterizing the firstfiring 4172 of the surgical device 235 identified by ID 002 will bepaired with the outcome of the lung resection surgical procedure,transmitted to the surgical hub 206, anonymized, and either stored inthe surgical hub 206 or transmitted to the cloud 204 for aggregation,further processing, analysis, etc.

FIG. 75 is a diagram 4200 illustrating a staple line visualization laserDoppler to evaluate the integrity of staple line seals by monitoringbleeding of a vessel after a firing of a surgical stapler, according toone aspect of the present disclosure. A laser Doppler technique isdescribed in above under the heading “Advanced Imaging AcquisitionModule,” in U.S. Provisional Patent Application Ser. No. 62/611,341,filed Dec. 28, 2017, and entitled INTERACTIVE SURGICAL PLATFORM, whichis hereby incorporated by reference herein in its entirety. The laserDoppler provides an image 4202 suitable for inspecting seals along thestaple lines 4180 a, 4180 b, 4182 a and for visualizing bleeding 4206 ofany defective seals. Laser Doppler inspection of the first firing 4172of device 002 shows a defective seal at the first staple line 4180 a ofthe first portion 4166 a of the bronchial vessel sealed during the firstfiring 4172. The staple line 4180 a seal is bleeding 4206 out at avolume of 0.5 cc. The image 4202 is recorded at anonymous time 09:55:154204 and is paired with the force-to-close curve 4192 and force-to-firecurve 4194 shown in FIG. 74 . The data pair set is grouped by surgeryand is stored locally in the surgical hub 206 storage 248 and/orremotely to the cloud 204 storage 205 for aggregation, processing, andanalysis, for example. For example, the cloud 204 analytics engineassociates the information contained in the first self-describing packet4100 associated with the first firing 4172 and indicate that a defectiveseal was produced at the staple line 4166 a. Over time, this informationcan be aggregated, analyzed, and used to improve outcomes of thesurgical procedure, such as, resection of a lung tumor, for example.

FIG. 76 illustrates two paired data sets 4210 grouped by surgery,according to one aspect of the present disclosure. The upper paired dataset 4212 is grouped by one surgery and a lower paired data set 4214grouped by another surgery. The upper paired data set 4212, for example,is grouped by the lung tumor resection surgery discussed in connectionwith FIGS. 73-76 . Accordingly, the rest of the description of FIG. 76will reference information described in FIGS. 32-35 as well as FIGS.1-21 to show interaction with an interactive surgical system 100environment including a surgical hub 106, 206. The lower paired data set4214 is grouped by a liver tumor resection surgical procedure where thesurgeon treated parenchyma tissue. The upper paired data set isassociated with a failed staple line seal and the bottom paired data setis associated with a successful staple line seal. The upper and lowerpaired data sets 4212, 4214 are sampled by the instrument device 235 andeach sample formed into a self-describing data packet 4100 which istransmitted to the surgical hub 206 and eventually is transmitted fromthe surgical hub 206 to the cloud 204. The samples may be stored locallyin the instrument device 235 prior to packetizing or may be transmittedon the fly. Sampling rate and transmission rate are dictated bycommunication traffic in the surgical hub 206 and may be adjusteddynamically to accommodate current bandwidth limitations.

The upper paired data set 4212 includes a left data set 4216 recorded bythe instrument/device 235 during the first firing 4172 linked 4224 to aright data set 4218 recorded at the time the staple line seal 4180 a ofthe first bronchial vessel 4166 a was evaluated. The left data set 4216indicates a “Vessel” tissue type 4236 having a thickness 4238 of 1.1 mm.Also included in the left data set 4216 is the force-to-close curve 4192and force-to-fire curve 4194 versus time (anonymous real time) recordedduring the first firing 4172 of the lung tumor resection surgicalprocedure. The left data set 4216 shows that the force-to-fire peaked at85 Lbs. and recorded at anonymous real time 4240 t₁ a (09:35:15). Theright data set 4218 depicts the staple line visualization curve 4228depicting leakage versus time. The right data set 4218 indicates that a“Vessel” tissue type 4244 having a thickness 4246 of 1.1 mm experienceda staple line 4180 a seal failure 4242. The staple line visualizationcurve 4228 depicts leakage volume (cc) versus time of the staple line4180 a seal. The staple line visualization curve 4228 shows that theleakage volume reached 0.5 cc, indicating a failed staple line 4180 aseal of the bronchial vessel 4166 a, recorded at anonymous time 4248(09:55:15).

The lower paired data set 4214 includes a left data set 4220 recorded bythe instrument/device 235 during a firing linked 4226 to a right dataset 4222 recorded at the time the staple line seal of the parenchymatissue was evaluated. The left data set 4220 indicates a “Parenchyma”tissue type 4236 having a thickness 4238 of 2.1 mm. Also included in theleft data set 4220 is the force-to-close curve 4230 and force-to-firecurve 4232 versus time (anonymous real time) recorded during the firstfiring of the liver tumor resection surgical procedure. The left dataset 4220 shows that the force-to-fire peaked at 100 Lbs. and recorded atanonymous real time 4240 t₁ b (09:42:12). The right data set 4222depicts the staple line visualization curve 4228 depicting leakageversus time. The right data set 4234 indicates that a “Parenchyma”tissue type 4244 having a thickness 4246 of 2.2 mm experienced asuccessful staple line seal. The staple line visualization curve 4234depicts leakage volume (cc) versus time of the staple line seal. Thestaple line visualization curve 4234 shows that the leakage volume was0.0 cc, indicating a successful staple line seal of the parenchymatissue, recorded at anonymous time 4248 (10:02:12).

The paired date sets 4212, 4214 grouped by surgery are collected formany procedures and the data contained in the paired date sets 4212,4214 is recorded and stored in the cloud 204 storage 205 anonymously toprotect patient privacy, as described in connection with FIGS. 62-69 .In one aspect, the paired date sets 4212, 4214 data are transmitted fromthe instrument/device 235, or other modules coupled to the surgical hub206, to the surgical hub 206 and to the cloud 204 in the form of theself-describing packet 4100 as described in connection with FIGS. 71 and72 and surgical procedure examples described in connection with FIGS.72-76 . The paired date sets 4212, 4214 data stored in the cloud 204storage 205 is analyzed in the cloud 204 to provide feedback to theinstrument/device 235, or other modules coupled to the surgical hub 206,notifying a surgical robot coupled to the robot hub 222, or the surgeon,that the conditions identified by the left data set ultimately lead toeither a successful or failed seal. As described in connection with FIG.76 , the upper left data set 4216 led to a failed seal and the bottomleft data set 4220 led to a successful seal. This is advantageousbecause the information provided in a paired data set grouped by surgerycan be used to improve resection, transection, and creation ofanastomosis in a variety of tissue types. The information can be used toavoid pitfalls that may lead to a failed seal.

FIG. 77 is a diagram of the right lung 4156 and FIG. 78 is a diagram ofthe bronchial tree 4250 including the trachea 4252 and the bronchi 4254,4256 of the lungs. As shown in FIG. 77 , the right lung 4156 is composedof three lobes divided into the upper lobe 4162, the middle lobe 4160,and the lower lobe 4165 separated by the oblique fissure 4167 andhorizontal fissure 4160. The left lung is composed of only two smallerlobes due to the position of heart. As shown in FIG. 78 , inside eachlung, the right bronchus 4254 and the left bronchus 4256 divide intomany smaller airways called bronchioles 4258, greatly increasing surfacearea. Each bronchiole 4258 terminates with a cluster of air sacs calledalveoli 4260, where gas exchange with the bloodstream occurs.

FIG. 79 is a logic flow diagram 4300 of a process depicting a controlprogram or a logic configuration for storing paired anonymous data setsgrouped by surgery, according to one aspect of the present disclosure.With reference to FIGS. 1-79 , in one aspect, the present disclosureprovides a surgical hub 206 configured to communicate with a surgicalinstrument 235. The surgical hub 206 comprises a processor 244 and amemory 249 coupled to the processor 244. The memory 249 storinginstructions executable by the processor 244 to receive 4302 a firstdata set from a first source, the first data set associated with asurgical procedure, receive 4304 a second data set from a second source,the second data set associated with the efficacy of the surgicalprocedure, anonymize 4306 the first and second data sets by removinginformation that identifies a patient, a surgery, or a scheduled time ofthe surgery, and store 4308 the first and second anonymized data sets togenerate a data pair grouped by surgery. The first data set is generatedat a first time, the second data set is generated at a second time, andthe second time is separate and distinct from the first time.

In another aspect, the memory 249 stores instructions executable by theprocessor 244 to reconstruct a series of chronological events based onthe data pair. In another aspect, the memory 249 stores instructionsexecutable by the processor 244 to reconstruct a series of coupled butunconstrained data sets based on the data pair. In another aspect, thememory 249 stores instructions executable by the processor 244 toencrypt the data pair, define a backup format for the data pair, andmirror the data pair to a cloud 204 storage device 205.

Determination of Data to Transmit to Cloud Based Medical Analytics

In one aspect, the present disclosure provides a communication hub andstorage device for storing parameters and status of a surgical devicewhat has the ability to determine when, how often, transmission rate,and type of data to be shared with a cloud based analytics system. Thedisclosure further provides techniques to determine where the analyticssystem communicates new operational parameters for the hub and surgicaldevices.

In a surgical hub environment, large amounts of data can be generatedrather quickly and may cause storage and communication bottlenecks inthe surgical hub network. One solution may include local determinationof when and what data is transmitted for to the cloud-based medicalanalytics system for further processing and manipulation of surgical hubdata. The timing and rate at which the surgical hub data is exported canbe determined based on available local data storage capacity. Userdefined inclusion or exclusion of specific users, patients, orprocedures enable data sets to be included for analysis or automaticallydeleted. The time of uploads or communications to the cloud-basedmedical analytics system may be determined based on detected surgicalhub network down time or available capacity.

With reference to FIGS. 1-79 , in one aspect, the present disclosureprovides a surgical hub 206 comprising a storage device 248, a processor244 coupled to the storage device 248, and a memory 249 coupled to theprocessor 244. The memory 249 stores instructions executable by theprocessor 244 to receive data from a surgical instrument 235, determinea rate at which to transfer the data to a remote cloud-based medicalanalytics network 204 based on available storage capacity of the storagedevice 248, determine a frequency at which to transfer the data to theremote cloud-based medical analytics network 204 based on the availablestorage capacity of the storage device 248 or detected surgical hubnetwork 206 down time, and determine a type of data to transfer the datato a remote cloud-based medical analytics network 204 based on inclusionor exclusion of data associated with a users, patient, or surgicalprocedure.

In another aspect, the memory 249 stores instructions executable by theprocessor 244 to receive new operational parameters for the surgical hub206 or the surgical instrument 235.

In various aspects, the present disclosure provides a control circuit todetermine, rate, frequency and type of data to transfer the data to theremote cloud-based medical analytics network as described above. Invarious aspects, the present disclosure provides a non-transitorycomputer-readable medium storing computer readable instructions which,when executed, causes a machine to determine, rate, frequency and typeof data to transfer to the remote cloud-based medical analytics network.

In one aspect, the surgical hub 206 is configured to determine what datato transmit to the cloud based analytics system 204. For example, asurgical hub 206 modular device 235 that includes local processingcapabilities may determine the rate, frequency, and type of data to betransmitted to the cloud based analytics system 204 for analysis andprocessing.

In one aspect, the surgical hub 206 comprises a modular communicationhub 203 and storage device 248 for storing parameters and status of adevice 235 that has the ability to determine when and how often data canbe shared with a cloud based analytics system 204, the transmission rateand the type of data that can be shared with the cloud based analyticssystem 204. In another aspect, the cloud analytics system 204communicates new operational parameters for the surgical hub 206 andsurgical devices 235 coupled to the surgical hub 206. A cloud basedanalytics system 204 is described in commonly-owned U.S. ProvisionalPatent Application Ser. No. 62/611,340, filed Dec. 28, 2017, andentitled CLOUD-BASED MEDICAL ANALYTICS, which is incorporated herein byreference in its entirety.

In one aspect, a device 235 coupled to a local surgical hub 206determines when and what data is transmitted to the cloud analyticssystem 204 for company analytic improvements. In one example, theavailable local data storage capacity remaining in the storage device248 controls the timing and rate at which the data is exported. Inanother example, user defined inclusion or exclusion of specific users,patients, or procedures allows data sets to be included for analysis orautomatically deleted. In yet another example, detected network downtime or available capacity determines the time of uploads orcommunications.

In another aspect, transmission of data for diagnosis of failure modesis keyed by specific incidents. For example, user defined failure of adevice, instrument, or tool within a procedure initiates archiving andtransmission of data recorded with respect to that instrument forfailure modes analysis. Further, when a failure event is identified, allthe data surrounding the event is archived and packaged for sending backfor predictive informatics (PI) analytics. Data that is part of a PIfailure is flagged for storage and maintenance until either the hospitalor the cloud based analytics system releases the hold on the data.

Catastrophic failures of instruments may initiate an automatic archiveand submission of data for implications analysis. Detection of acounterfeit component or adapter on an original equipment manufacturer(OEM) device initiates documentation of the component and recording ofthe results and outcome of its use.

FIG. 80 is a logic flow diagram 4320 of a process depicting a controlprogram or a logic configuration for determining rate, frequency, andtype of data to transfer to a remote cloud-based analytics network,according to one aspect of the present disclosure. With reference toFIGS. 1-80 , in one aspect, the present disclosure provides a surgicalhub 206 comprising a storage device 248, a processor 244 coupled to thestorage device 248, and a memory 249 coupled to the processor 244. Thememory 249 stores instructions executable by the processor 244 toreceive 4322 data from a surgical instrument 235, determine 4324 a rateat which to transfer the data to a remote cloud-based medical analyticsnetwork 204 based on available storage capacity of the storage device248. Optionally, the memory 249 stores instructions executable by theprocessor 244 to determine 4326 a frequency at which to transfer thedata to the remote cloud-based medical analytics network 204 based onthe available storage capacity of the storage device 248. Optionally,the memory 249 stores instructions executable by the processor 244 todetect surgical hub network downtime and to determine 4326 a frequencyat which to transfer the data to the remote cloud-based medicalanalytics network 204 based on the detected surgical hub network 206down time. Optionally, the memory 249 stores instructions executable bythe processor 244 to determine 4328 a type of data to transfer the datato a remote cloud-based medical analytics network 204 based on inclusionor exclusion of data associated with a users, patient, or surgicalprocedure.

In another aspect, the memory 249 stores instructions executable by theprocessor 244 to receive new operational parameters for the surgical hub206 or the surgical instrument 235.

In one aspect, the present disclosure provides a surgical hub,comprising: a processor; and a memory coupled to the processor, thememory storing instructions executable by the processor to: interrogatea surgical instrument, wherein the surgical instrument is a first sourceof patient data; retrieve a first data set from the surgical instrument,wherein the first data set is associated with a patient and a surgicalprocedure; interrogate a medical imaging device, wherein the medicalimaging device is a second source of patient data; retrieve a seconddata set from the medical imaging device, wherein the second data set isassociated with the patient and an outcome of the surgical procedure;associate the first and second data sets by a key; and transmit theassociated first and second data sets to remote network outside of thesurgical hub. The present disclosure further provides, a surgical hubwherein the memory stores instructions executable by the processor to:retrieve the first data set using the key; anonymize the first data setby removing its association with the patient; retrieve the second dataset using the key; anonymize the second data set by removing itsassociation with the patient; pair the anonymized first and second datasets; and determine success rates of surgical procedures grouped by thesurgical procedure based on the anonymized paired first and second datasets. The present disclosure further provides a surgical hub, whereinthe memory stores instructions executable by the processor to: retrievethe anonymized first data set; retrieve the anonymized second data set;and reintegrate the anonymized first and second data sets using the key.The present disclosure further provides a surgical hub, wherein thefirst and second data sets define first and second data payloads inrespective first and second data packets. The present disclosure furtherprovides a control circuit to perform any one of the above recitedfunctions and/or a non-transitory computer readable medium storingcomputer readable instructions which, when executed, causes a machine toperform any one of the above recited functions.

In another aspect, the present disclosure provides a surgical hub,comprising: a processor; and a memory coupled to the processor, thememory storing instructions executable by the processor to: receive afirst data packet from a first source, the first data packet comprisinga first preamble, a first data payload, a source of the first datapayload, and a first encryption certificate, wherein the first preambledefines the first data payload and the first encryption certificateverifies the authenticity of the first data packet; receive a seconddata packet from a second source, the second data packet comprising asecond preamble, a second data payload, a source of the second datapayload, and a second encryption certificate, wherein the secondpreamble defines the second data payload and the second encryptioncertificate verifies the authenticity of the second data packet;associate the first and second data packets; and generate a third datapacket comprising the first and second data payloads. The presentdisclosure further provides a surgical hub, wherein the memory storesinstructions executable by the processor to: determine that a datapayload is from a new source; verify the new source of the data payload;and alter a data collection process at the surgical hub to receivesubsequent data packets from the new source. The present disclosurefurther provides a surgical, wherein the memory stores instructionsexecutable by the processor to associate the first and second datapackets based on a key. The present disclosure further provides asurgical hub, wherein the memory stores instructions executable by theprocessor to anonymize the data payload of the third data packet. Thepresent disclosure further provides a surgical hub, wherein the memorystores instructions executable by the processor to receive an anonymizedthird data packet and reintegrate the anonymized third data packet intothe first and second data packets using the key. The present disclosurefurther provides a control circuit to perform any one of the aboverecited functions and/or a non-transitory computer readable mediumstoring computer readable instructions which, when executed, causes amachine to perform any one of the above recited functions.

In another aspect, the present disclosure provides a surgical hubconfigured to communicate with a surgical instrument, the surgical hubcomprising: a processor; and a memory coupled to the processor, thememory storing instructions executable by the processor to: receive afirst data set associated with a surgical procedure, wherein the firstdata set is generated at a first time; receive a second data setassociated with the efficacy of the surgical procedure, wherein thesecond data set is generated at a second time, wherein the second timeis separate and distinct from the first time; anonymize the first andsecond data sets by removing information that identifies a patient, asurgery, or a scheduled time of the surgery; and store the first andsecond anonymized data sets to generate a data pair grouped by surgery.The present disclosure further provides a surgical hub, wherein thememory stores instructions executable by the processor to reconstruct aseries of chronological events based on the data pair. The presentdisclosure further provides a surgical hub, wherein the memory storesinstructions executable by the processor to reconstruct a series ofcoupled but unconstrained data sets based on the data pair. The presentdisclosure further provides a surgical hub, wherein the memory storesinstructions executable by the processor to: encrypt the data pair;define a backup format for the data pair; and mirror the data pair to acloud storage device. The present disclosure further provides a controlcircuit to perform any one of the above recited functions and/or anon-transitory computer readable medium storing computer readableinstructions which, when executed, causes a machine to perform any oneof the above recited functions.

In another aspect, the present disclosure provides a surgical hubcomprising: a storage device; a processor coupled to the storage device;and a memory coupled to the processor, the memory storing instructionsexecutable by the processor to: receive data from a surgical instrument;determine a rate at which to transfer the data to a remote cloud-basedmedical analytics network based on available storage capacity of thestorage device; determine a frequency at which to transfer the data tothe remote cloud-based medical analytics network based on the availablestorage capacity of the storage device or detected surgical hub networkdown time; and determine a type of data to transfer the data to a remotecloud-based medical analytics network based on inclusion or exclusion ofdata associated with a users, patient, or surgical procedure. Thepresent disclosure further provides a surgical hub, wherein the memorystores instructions executable by the processor to receive newoperational parameters for the surgical hub or the surgical instrument.The present disclosure further provides a control circuit to perform anyone of the above recited functions and/or a non-transitory computerreadable medium storing computer readable instructions which, whenexecuted, causes a machine to perform any one of the above recitedfunctions.

In another aspect, the present disclosure provides a surgical hubcomprising: a control configured to: receive data from a surgicalinstrument; determine a rate at which to transfer the data to a remotecloud-based medical analytics network based on available storagecapacity of the storage device; determine a frequency at which totransfer the data to the remote cloud-based medical analytics networkbased on the available storage capacity of the storage device ordetected surgical hub network down time; and determine a type of data totransfer the data to a remote cloud-based medical analytics networkbased on inclusion or exclusion of data associated with a users,patient, or surgical procedure.

Surgical Hub Situational Awareness

Although an “intelligent” device including control algorithms thatrespond to sensed data can be an improvement over a “dumb” device thatoperates without accounting for sensed data, some sensed data can beincomplete or inconclusive when considered in isolation, i.e., withoutthe context of the type of surgical procedure being performed or thetype of tissue that is being operated on. Without knowing the proceduralcontext (e.g., knowing the type of tissue being operated on or the typeof procedure being performed), the control algorithm may control themodular device incorrectly or suboptimally given the particularcontext-free sensed data. For example, the optimal manner for a controlalgorithm to control a surgical instrument in response to a particularsensed parameter can vary according to the particular tissue type beingoperated on. This is due to the fact that different tissue types havedifferent properties (e.g., resistance to tearing) and thus responddifferently to actions taken by surgical instruments. Therefore, it maybe desirable for a surgical instrument to take different actions evenwhen the same measurement for a particular parameter is sensed. As onespecific example, the optimal manner in which to control a surgicalstapling and cutting instrument in response to the instrument sensing anunexpectedly high force to close its end effector will vary dependingupon whether the tissue type is susceptible or resistant to tearing. Fortissues that are susceptible to tearing, such as lung tissue, theinstrument's control algorithm would optimally ramp down the motor inresponse to an unexpectedly high force to close to avoid tearing thetissue. For tissues that are resistant to tearing, such as stomachtissue, the instrument's control algorithm would optimally ramp up themotor in response to an unexpectedly high force to close to ensure thatthe end effector is clamped properly on the tissue. Without knowingwhether lung or stomach tissue has been clamped, the control algorithmmay make a suboptimal decision.

One solution utilizes a surgical hub including a system that isconfigured to derive information about the surgical procedure beingperformed based on data received from various data sources and thencontrol the paired modular devices accordingly. In other words, thesurgical hub is configured to infer information about the surgicalprocedure from received data and then control the modular devices pairedto the surgical hub based upon the inferred context of the surgicalprocedure. FIG. 81 illustrates a diagram of a situationally awaresurgical system 5100, in accordance with at least one aspect of thepresent disclosure. In some exemplifications, the data sources 5126include, for example, the modular devices 5102 (which can includesensors configured to detect parameters associated with the patientand/or the modular device itself), databases 5122 (e.g., an EMR databasecontaining patient records), and patient monitoring devices 5124 (e.g.,a blood pressure (BP) monitor and an electrocardiography (EKG) monitor).The surgical hub 5104 can be configured to derive the contextualinformation pertaining to the surgical procedure from the data basedupon, for example, the particular combination(s) of received data or theparticular order in which the data is received from the data sources5126. The contextual information inferred from the received data caninclude, for example, the type of surgical procedure being performed,the particular step of the surgical procedure that the surgeon isperforming, the type of tissue being operated on, or the body cavitythat is the subject of the procedure. This ability by some aspects ofthe surgical hub 5104 to derive or infer information related to thesurgical procedure from received data can be referred to as “situationalawareness.” In one exemplification, the surgical hub 5104 canincorporate a situational awareness system, which is the hardware and/orprogramming associated with the surgical hub 5104 that derivescontextual information pertaining to the surgical procedure from thereceived data.

The situational awareness system of the surgical hub 5104 can beconfigured to derive the contextual information from the data receivedfrom the data sources 5126 in a variety of different ways. In oneexemplification, the situational awareness system includes a patternrecognition system, or machine learning system (e.g., an artificialneural network), that has been trained on training data to correlatevarious inputs (e.g., data from databases 5122, patient monitoringdevices 5124, and/or modular devices 5102) to corresponding contextualinformation regarding a surgical procedure. In other words, a machinelearning system can be trained to accurately derive contextualinformation regarding a surgical procedure from the provided inputs. Inanother exemplification, the situational awareness system can include alookup table storing pre-characterized contextual information regardinga surgical procedure in association with one or more inputs (or rangesof inputs) corresponding to the contextual information. In response to aquery with one or more inputs, the lookup table can return thecorresponding contextual information for the situational awarenesssystem for controlling the modular devices 5102. In one exemplification,the contextual information received by the situational awareness systemof the surgical hub 5104 is associated with a particular controladjustment or set of control adjustments for one or more modular devices5102. In another exemplification, the situational awareness systemincludes a further machine learning system, lookup table, or other suchsystem, which generates or retrieves one or more control adjustments forone or more modular devices 5102 when provided the contextualinformation as input.

A surgical hub 5104 incorporating a situational awareness systemprovides a number of benefits for the surgical system 5100. One benefitincludes improving the interpretation of sensed and collected data,which would in turn improve the processing accuracy and/or the usage ofthe data during the course of a surgical procedure. To return to aprevious example, a situationally aware surgical hub 5104 coulddetermine what type of tissue was being operated on; therefore, when anunexpectedly high force to close the surgical instrument's end effectoris detected, the situationally aware surgical hub 5104 could correctlyramp up or ramp down the motor of the surgical instrument for the typeof tissue.

As another example, the type of tissue being operated can affect theadjustments that are made to the compression rate and load thresholds ofa surgical stapling and cutting instrument for a particular tissue gapmeasurement. A situationally aware surgical hub 5104 could infer whethera surgical procedure being performed is a thoracic or an abdominalprocedure, allowing the surgical hub 5104 to determine whether thetissue clamped by an end effector of the surgical stapling and cuttinginstrument is lung (for a thoracic procedure) or stomach (for anabdominal procedure) tissue. The surgical hub 5104 could then adjust thecompression rate and load thresholds of the surgical stapling andcutting instrument appropriately for the type of tissue.

As yet another example, the type of body cavity being operated in duringan insufflation procedure can affect the function of a smoke evacuator.A situationally aware surgical hub 5104 could determine whether thesurgical site is under pressure (by determining that the surgicalprocedure is utilizing insufflation) and determine the procedure type.As a procedure type is generally performed in a specific body cavity,the surgical hub 5104 could then control the motor rate of the smokeevacuator appropriately for the body cavity being operated in. Thus, asituationally aware surgical hub 5104 could provide a consistent amountof smoke evacuation for both thoracic and abdominal procedures.

As yet another example, the type of procedure being performed can affectthe optimal energy level for an ultrasonic surgical instrument or radiofrequency (RF) electrosurgical instrument to operate at. Arthroscopicprocedures, for example, require higher energy levels because the endeffector of the ultrasonic surgical instrument or RF electrosurgicalinstrument is immersed in fluid. A situationally aware surgical hub 5104could determine whether the surgical procedure is an arthroscopicprocedure. The surgical hub 5104 could then adjust the RF power level orthe ultrasonic amplitude of the generator (i.e., “energy level”) tocompensate for the fluid filled environment. Relatedly, the type oftissue being operated on can affect the optimal energy level for anultrasonic surgical instrument or RF electrosurgical instrument tooperate at. A situationally aware surgical hub 5104 could determine whattype of surgical procedure is being performed and then customize theenergy level for the ultrasonic surgical instrument or RFelectrosurgical instrument, respectively, according to the expectedtissue profile for the surgical procedure. Furthermore, a situationallyaware surgical hub 5104 can be configured to adjust the energy level forthe ultrasonic surgical instrument or RF electrosurgical instrumentthroughout the course of a surgical procedure, rather than just on aprocedure-by-procedure basis. A situationally aware surgical hub 5104could determine what step of the surgical procedure is being performedor will subsequently be performed and then update the control algorithmsfor the generator and/or ultrasonic surgical instrument or RFelectrosurgical instrument to set the energy level at a valueappropriate for the expected tissue type according to the surgicalprocedure step.

As yet another example, data can be drawn from additional data sources5126 to improve the conclusions that the surgical hub 5104 draws fromone data source 5126. A situationally aware surgical hub 5104 couldaugment data that it receives from the modular devices 5102 withcontextual information that it has built up regarding the surgicalprocedure from other data sources 5126. For example, a situationallyaware surgical hub 5104 can be configured to determine whetherhemostasis has occurred (i.e., whether bleeding at a surgical site hasstopped) according to video or image data received from a medicalimaging device. However, in some cases the video or image data can beinconclusive. Therefore, in one exemplification, the surgical hub 5104can be further configured to compare a physiologic measurement (e.g.,blood pressure sensed by a BP monitor communicably connected to thesurgical hub 5104) with the visual or image data of hemostasis (e.g.,from a medical imaging device 124 (FIG. 2 ) communicably coupled to thesurgical hub 5104) to make a determination on the integrity of thestaple line or tissue weld. In other words, the situational awarenesssystem of the surgical hub 5104 can consider the physiologicalmeasurement data to provide additional context in analyzing thevisualization data. The additional context can be useful when thevisualization data may be inconclusive or incomplete on its own.

Another benefit includes proactively and automatically controlling thepaired modular devices 5102 according to the particular step of thesurgical procedure that is being performed to reduce the number of timesthat medical personnel are required to interact with or control thesurgical system 5100 during the course of a surgical procedure. Forexample, a situationally aware surgical hub 5104 could proactivelyactivate the generator to which an RF electrosurgical instrument isconnected if it determines that a subsequent step of the procedurerequires the use of the instrument. Proactively activating the energysource allows the instrument to be ready for use a soon as the precedingstep of the procedure is completed.

As another example, a situationally aware surgical hub 5104 coulddetermine whether the current or subsequent step of the surgicalprocedure requires a different view or degree of magnification on thedisplay according to the feature(s) at the surgical site that thesurgeon is expected to need to view. The surgical hub 5104 could thenproactively change the displayed view (supplied by, e.g., a medicalimaging device for the visualization system 108) accordingly so that thedisplay automatically adjusts throughout the surgical procedure.

As yet another example, a situationally aware surgical hub 5104 coulddetermine which step of the surgical procedure is being performed orwill subsequently be performed and whether particular data orcomparisons between data will be required for that step of the surgicalprocedure. The surgical hub 5104 can be configured to automatically callup data screens based upon the step of the surgical procedure beingperformed, without waiting for the surgeon to ask for the particularinformation.

Another benefit includes checking for errors during the setup of thesurgical procedure or during the course of the surgical procedure. Forexample, a situationally aware surgical hub 5104 could determine whetherthe operating theater is setup properly or optimally for the surgicalprocedure to be performed. The surgical hub 5104 can be configured todetermine the type of surgical procedure being performed, retrieve thecorresponding checklists, product location, or setup needs (e.g., from amemory), and then compare the current operating theater layout to thestandard layout for the type of surgical procedure that the surgical hub5104 determines is being performed. In one exemplification, the surgicalhub 5104 can be configured to compare the list of items for theprocedure (scanned by the scanner 5132 depicted in FIG. 85B, forexample) and/or a list of devices paired with the surgical hub 5104 to arecommended or anticipated manifest of items and/or devices for thegiven surgical procedure. If there are any discontinuities between thelists, the surgical hub 5104 can be configured to provide an alertindicating that a particular modular device 5102, patient monitoringdevice 5124, and/or other surgical item is missing. In oneexemplification, the surgical hub 5104 can be configured to determinethe relative distance or position of the modular devices 5102 andpatient monitoring devices 5124 via proximity sensors, for example. Thesurgical hub 5104 can compare the relative positions of the devices to arecommended or anticipated layout for the particular surgical procedure.If there are any discontinuities between the layouts, the surgical hub5104 can be configured to provide an alert indicating that the currentlayout for the surgical procedure deviates from the recommended layout.

As another example, a situationally aware surgical hub 5104 coulddetermine whether the surgeon (or other medical personnel) was making anerror or otherwise deviating from the expected course of action duringthe course of a surgical procedure. For example, the surgical hub 5104can be configured to determine the type of surgical procedure beingperformed, retrieve the corresponding list of steps or order ofequipment usage (e.g., from a memory), and then compare the steps beingperformed or the equipment being used during the course of the surgicalprocedure to the expected steps or equipment for the type of surgicalprocedure that the surgical hub 5104 determined is being performed. Inone exemplification, the surgical hub 5104 can be configured to providean alert indicating that an unexpected action is being performed or anunexpected device is being utilized at the particular step in thesurgical procedure.

Overall, the situational awareness system for the surgical hub 5104improves surgical procedure outcomes by adjusting the surgicalinstruments (and other modular devices 5102) for the particular contextof each surgical procedure (such as adjusting to different tissue types)and validating actions during a surgical procedure. The situationalawareness system also improves surgeons' efficiency in performingsurgical procedures by automatically suggesting next steps, providingdata, and adjusting displays and other modular devices 5102 in thesurgical theater according to the specific context of the procedure.

FIG. 82A illustrates a logic flow diagram of a process 5000 a forcontrolling a modular device 5102 according to contextual informationderived from received data, in accordance with at least one aspect ofthe present disclosure. In other words, a situationally aware surgicalhub 5104 can execute the process 5000 a to determine appropriate controladjustments for modular devices 5102 paired with the surgical hub 5104before, during, or after a surgical procedure as dictated by the contextof the surgical procedure. In the following description of the process5000 a, reference should also be made to FIG. 81 . In oneexemplification, the process 5000 a can be executed by a control circuitof a surgical hub 5104, as depicted in FIG. 10 (processor 244). Inanother exemplification, the process 5000 a can be executed by a cloudcomputing system 104, as depicted in FIG. 1 . In yet anotherexemplification, the process 5000 a can be executed by a distributedcomputing system including at least one of the aforementioned cloudcomputing system 104 and/or a control circuit of a surgical hub 5104 incombination with a control circuit of a modular device, such as themicrocontroller 461 of the surgical instrument depicted in FIG. 12 , themicrocontroller 620 of the surgical instrument depicted in FIG. 16 , thecontrol circuit 710 of the robotic surgical instrument 700 depicted inFIG. 17 , the control circuit 760 of the surgical instruments 750, 790depicted in FIGS. 18 and 19 , or the controller 838 of the generator 800depicted in FIG. 20 . For economy, the following description of theprocess 5000 a will be described as being executed by the controlcircuit of a surgical hub 5104; however, it should be understood thatthe description of the process 5000 a encompasses all of theaforementioned exemplifications.

The control circuit of the surgical hub 5104 executing the process 5000a receives 5004 a data from one or more data sources 5126 to which thesurgical hub 5104 is communicably connected. The data sources 5126include, for example, databases 5122, patient monitoring devices 5124,and modular devices 5102. In one exemplification, the databases 5122 caninclude a patient EMR database associated with the medical facility atwhich the surgical procedure is being performed. The data received 5004a from the data sources 5126 can include perioperative data, whichincludes preoperative data, intraoperative data, and/or postoperativedata associated with the given surgical procedure. The data received5004 a from the databases 5122 can include the type of surgicalprocedure being performed or the patient's medical history (e.g.,medical conditions that may or may not be the subject of the presentsurgical procedure). In one exemplification depicted in FIG. 83A, thecontrol circuit can receive 5004 a the patient or surgical proceduredata by querying the patient EMR database with a unique identifierassociated with the patient. The surgical hub 5104 can receive theunique identifier from, for example, a scanner 5128 for scanning thepatient's wristband 5130 encoding the unique identifier associated withthe patient when the patient enters the operating theater, as depictedin FIG. 85A. In one exemplification, the patient monitoring devices 5124include BP monitors, EKG monitors, and other such devices that areconfigured to monitor one or more parameters associated with a patient.As with the modular devices 5102, the patient monitoring devices 5124can be paired with the surgical hub 5104 such that the surgical hub 5104receives 5004 a data therefrom. In one exemplification, the datareceived 5004 a from the modular devices 5102 that are paired with(i.e., communicably coupled to) the surgical hub 5104 includes, forexample, activation data (i.e., whether the device is powered on or inuse), data of the internal state of the modular device 5102 (e.g., forceto fire or force to close for a surgical cutting and stapling device,pressure differential for an insufflator or smoke evacuator, or energylevel for an RF or ultrasonic surgical instrument), or patient data(e.g., tissue type, tissue thickness, tissue mechanical properties,respiration rate, or airway volume).

As the process 5000 a continues, the control circuit of the surgical hub5104 can derive 5006 a contextual information from the data received5004 a from the data sources 5126. The contextual information caninclude, for example, the type of procedure being performed, theparticular step being performed in the surgical procedure, the patient'sstate (e.g., whether the patient is under anesthesia or whether thepatient is in the operating room), or the type of tissue being operatedon. The control circuit can derive 5006 a contextual informationaccording to data from ether an individual data source 5126 orcombinations of data sources 5126. Further, the control circuit canderive 5006 a contextual information according to, for example, thetype(s) of data that it receives, the order in which the data isreceived, or particular measurements or values associated with the data.For example, if the control circuit receives data from an RF generatorindicating that the RF generator has been activated, the control circuitcould thus infer that the RF electrosurgical instrument is now in useand that the surgeon is or will be performing a step of the surgicalprocedure utilizing the particular instrument. As another example, ifthe control circuit receives data indicating that a laparoscope imagingdevice has been activated and an ultrasonic generator is subsequentlyactivated, the control circuit can infer that the surgeon is on alaparoscopic dissection step of the surgical procedure due to the orderin which the events occurred. As yet another example, if the controlcircuit receives data from a ventilator indicating that the patient'srespiration is below a particular rate, then the control circuit candetermine that the patient is under anesthesia.

The control circuit can then determine 5008 a what control adjustmentsare necessary (if any) for one or more modular devices 5102 according tothe derived 5006 a contextual information. After determining 5008 a thecontrol adjustments, the control circuit of the surgical hub 5104 canthen control 5010 a the modular devices according to the controladjustments (if the control circuit determined 5008 a that any werenecessary). For example, if the control circuit determines that anarthroscopic procedure is being performed and that the next step in theprocedure utilizes an RF or ultrasonic surgical instrument in a liquidenvironment, the control circuit can determine 5008 a that a controladjustment for the generator of the RF or ultrasonic surgical instrumentis necessary to preemptively increase the energy output of theinstrument (because such instruments require increased energy in liquidenvironments to maintain their effectiveness). The control circuit canthen control 5010 a the generator and/or the RF or ultrasonic surgicalinstrument accordingly by causing the generator to increase its outputand/or causing the RF or ultrasonic surgical instrument to increase theenergy drawn from the generator. The control circuit can control 5010 athe modular devices 5102 according to the determined 5008 a controladjustment by, for example, transmitting the control adjustments to theparticular modular device to update the modular device's 5102programming. In another exemplification wherein the modular device(s)5102 and the surgical hub 5104 are executing a distributed computingarchitecture, the control circuit can control 5010 a the modular device5102 according to the determined 5008 a control adjustments by updatingthe distributed program.

FIGS. 82B-D illustrate representative implementations of the process5000 a depicted in FIG. 82A. As with the process 5000 a depicted in FIG.82A, the processes illustrated in FIGS. 82B-D can, in oneexemplification, be executed by a control circuit of the surgical hub5104. FIG. 82B illustrates a logic flow diagram of a process 5000 b forcontrolling a second modular device according to contextual informationderived from perioperative data received from a first modular device, inaccordance with at least one aspect of the present disclosure. In theillustrated exemplification, the control circuit of the surgical hub5104 receives 5004 b perioperative data from a first modular device. Theperioperative data can include, for example, data regarding the modulardevice 5102 itself (e.g., pressure differential, motor current, internalforces, or motor torque) or data regarding the patient with which themodular device 5102 is being utilized (e.g., tissue properties,respiration rate, airway volume, or laparoscopic image data). Afterreceiving 5004 b the perioperative data, the control circuit of thesurgical hub 5104 derives 5006 b contextual information from theperioperative data. The contextual information can include, for example,the procedure type, the step of the procedure being performed, or thestatus of the patient. The control circuit of the surgical hub 5104 thendetermines 5008 b control adjustments for a second modular device basedupon the derived 5006 b contextual information and then controls 5010 bthe second modular device accordingly. For example, the surgical hub5104 can receive 5004 b perioperative data from a ventilator indicatingthat the patient's lung has been deflated, derive 5006 b the contextualinformation therefrom that the subsequent step in the particularprocedure type utilizes a medical imaging device (e.g., a scope),determine 5008 b that the medical imaging device should be activated andset to a particular magnification, and then control 5010 b the medicalimaging device accordingly.

FIG. 82C illustrates a logic flow diagram of a process 5000 c forcontrolling a second modular device according to contextual informationderived from perioperative data received from a first modular device andthe second modular device. In the illustrated exemplification, thecontrol circuit of the surgical hub 5104 receives 5002 c perioperativedata from a first modular device and receives 5004 c perioperative datafrom a second modular device. After receiving 5002 c, 5004 c theperioperative data, the control circuit of the surgical hub 5104 derives5006 c contextual information from the perioperative data. The controlcircuit of the surgical hub 5104 then determines 5008 c controladjustments for the second modular device based upon the derived 5006 ccontextual information and then controls 5010 c the second modulardevice accordingly. For example, the surgical hub 5104 can receive 5002c perioperative data from a RF electrosurgical instrument indicatingthat the instrument has been fired, receive 5004 c perioperative datafrom a surgical stapling instrument indicating that the instrument hasbeen fired, derive 5006 c the contextual information therefrom that thesubsequent step in the particular procedure type requires that thesurgical stapling instrument be fired with a particular force (becausethe optimal force to fire can vary according to the tissue type beingoperated on), determine 5008 c the particular force thresholds thatshould be applied to the surgical stapling instrument, and then control5010 c the surgical stapling instrument accordingly.

FIG. 82D illustrates a logic flow diagram of a process 5000 d forcontrolling a third modular device according to contextual informationderived from perioperative data received from a first modular device anda second modular device. In the illustrated exemplification, the controlcircuit of the surgical hub 5104 receives 5002 d perioperative data froma first modular device and receives 5004 d perioperative data from asecond modular device. After receiving 5002 d, 5004 d the perioperativedata, the control circuit of the surgical hub 5104 derives 5006 dcontextual information from the perioperative data. The control circuitof the surgical hub 5104 then determines 5008 d control adjustments fora third modular device based upon the derived 5006 d contextualinformation and then controls 5010 d the third modular deviceaccordingly. For example, the surgical hub 5104 can receive 5002 d, 5004d perioperative data from an insufflator and a medical imaging deviceindicating that both devices have been activated and paired to thesurgical hub 5104, derive 5006 d the contextual information therefromthat a video-assisted thoracoscopic surgery (VATS) procedure is beingperformed, determine 5008 d that the displays connected to the surgicalhub 5104 should be set to display particular views or informationassociated with the procedure type, and then control 5010 d the displaysaccordingly.

FIG. 83A illustrates a diagram of a surgical system 5100 including asurgical hub 5104 communicably coupled to a particular set of datasources 5126. A surgical hub 5104 including a situational awarenesssystem can utilize the data received from the data sources 5126 toderive contextual information regarding the surgical procedure that thesurgical hub 5104, the modular devices 5102 paired to the surgical hub5104, and the patient monitoring devices 5124 paired to the surgical hub5104 are being utilized in connection with. The inferences (i.e.,contextual information) that one exemplification of the situationalawareness system can derive from the particular set of data sources 5126are depicted in dashed boxes extending from the data source(s) 5126 fromwhich they are derived. The contextual information derived from the datasources 5126 can include, for example, what step of the surgicalprocedure is being performed, whether and how a particular modulardevice 5102 is being used, and the patient's condition.

In the example illustrated in FIG. 83A, the data sources 5126 include adatabase 5122, a variety of modular devices 5102, and a variety ofpatient monitoring devices 5124. The surgical hub 5104 can be connectedto various databases 5122 to retrieve therefrom data regarding thesurgical procedure that is being performed or is to be performed. In oneexemplification of the surgical system 5100, the databases 5122 includean EMR database of a hospital. The data that can be received by thesituational awareness system of the surgical hub 5104 from the databases5122 can include, for example, start (or setup) time or operationalinformation regarding the procedure (e.g., a segmentectomy in the upperright portion of the thoracic cavity). The surgical hub 5104 can derivecontextual information regarding the surgical procedure from this dataalone or from the combination of this data and data from other datasources 5126.

The surgical hub 5104 can also be connected to (i.e., paired with) avariety of patient monitoring devices 5124. In one exemplification ofthe surgical system 5100, the patient monitoring devices 5124 that canbe paired with the surgical hub 5104 can include a pulse oximeter (SpO₂monitor) 5114, a BP monitor 5116, and an EKG monitor 5120. Theperioperative data that can be received by the situational awarenesssystem of the surgical hub 5104 from the patient monitoring devices 5124can include, for example, the patient's oxygen saturation, bloodpressure, heart rate, and other physiological parameters. The contextualinformation that can be derived by the surgical hub 5104 from theperioperative data transmitted by the patient monitoring devices 5124can include, for example, whether the patient is located in theoperating theater or under anesthesia. The surgical hub 5104 can derivethese inferences from data from the patient monitoring devices 5124alone or in combination with data from other data sources 5126 (e.g.,the ventilator 5118).

The surgical hub 5104 can also be connected to (i.e., paired with) avariety of modular devices 5102. In one exemplification of the surgicalsystem 5100, the modular devices 5102 that can be paired with thesurgical hub 5104 can include a smoke evacuator 5106, a medical imagingdevice 5108, an insufflator 5110, a combined energy generator 5112 (forpowering an ultrasonic surgical instrument and/or an RF electrosurgicalinstrument), and a ventilator 5118.

The medical imaging device 5108 includes an optical component and animage sensor that generates image data. The optical component includes alens or a light source, for example. The image sensor includes acharge-coupled device (CCD) or a complementary metal-oxide-semiconductor(CMOS), for example. In various exemplifications, the medical imagingdevice 5108 includes an endoscope, a laparoscope, a thoracoscope, andother such imaging devices. Various additional components of the medicalimaging device 5108 are described above. The perioperative data that canbe received by the surgical hub 5104 from the medical imaging device5108 can include, for example, whether the medical imaging device 5108is activated and a video or image feed. The contextual information thatcan be derived by the surgical hub 5104 from the perioperative datatransmitted by the medical imaging device 5108 can include, for example,whether the procedure is a VATS procedure (based on whether the medicalimaging device 5108 is activated or paired to the surgical hub 5104 atthe beginning or during the course of the procedure). Furthermore, theimage or video data from the medical imaging device 5108 (or the datastream representing the video for a digital medical imaging device 5108)can processed by a pattern recognition system or a machine learningsystem to recognize features (e.g., organs or tissue types) in the fieldof view (FOV) of the medical imaging device 5108, for example. Thecontextual information that can be derived by the surgical hub 5104 fromthe recognized features can include, for example, what type of surgicalprocedure (or step thereof) is being performed, what organ is beingoperated on, or what body cavity is being operated in.

In one exemplification depicted in FIG. 83B, the smoke evacuator 5106includes a first pressure sensor P₁ configured to detect the ambientpressure in the operating theater, a second pressure sensor P₂configured to detect the internal downstream pressure (i.e., thepressure downstream from the inlet), and a third pressure sensor P₃configured to detect the internal upstream pressure. In oneexemplification, the first pressure sensor Pi can be a separatecomponent from the smoke evacuator 5106 or otherwise located externallyto the smoke evacuator 5106. The perioperative data that can be receivedby the surgical hub 5104 from the smoke evacuator 5106 can include, forexample, whether the smoke evacuator 5106 is activated, pressurereadings from each of the sensors P₁, P₂, P₃, and pressure differentialsbetween pairs of the sensors P₁, P₂, P₃. The perioperative data can alsoinclude, for example, the type of tissue being operated on (based uponthe chemical composition of the smoke being evacuated) and the amount oftissue being cut. The contextual information that can be derived by thesurgical hub 5104 from the perioperative data transmitted by the smokeevacuator 5106 can include, for example, whether the procedure beingperformed is utilizing insufflation. The smoke evacuator 5106perioperative data can indicate whether the procedure is utilizinginsufflation according to the pressure differential between P₃ and P₁.If the pressure sensed by P₃ is greater than the pressure sensed by P₁(i.e., P₃−P₁>0), then the body cavity to which the smoke evacuator 5106is connected is insufflated. If the pressure sensed by P₃ is equal tothe pressure sensed by P₁ (i.e., P₃−P₁=0), then the body cavity is notinsufflated. When the body cavity is not insufflated, the procedure maybe an open type of procedure.

The insufflator 5110 can include, for example, pressure sensors andcurrent sensors configured to detect internal parameters of theinsufflator 5110. The perioperative data that can be received by thesurgical hub 5104 from the insufflator can include, for example, whetherthe insufflator 5110 is activated and the electrical current drawn bythe insufflator's 5110 pump. The surgical hub 5104 can determine whetherthe insufflator 5110 is activated by, for example, directly detectingwhether the device is powered on, detecting whether there is a pressuredifferential between an ambient pressure sensor and a pressure sensorinternal to the surgical site, or detecting whether the pressure valvesof the insufflator 5110 are pressurized (activated) or non-pressurized(deactivated). The contextual information that can be derived by thesurgical hub 5104 from the perioperative data transmitted by theinsufflator 5110 can include, for example, the type of procedure beingperformed (e.g., insufflation is utilized in laparoscopic procedures,but not arthroscopic procedures) and what body cavity is being operatedin (e.g., insufflation is utilized in the abdominal cavity, but not inthe thoracic cavity). In some exemplifications, the inferences derivedfrom the perioperative data received from different modular devices 5102can be utilized to confirm and/or increase the confidence of priorinferences. For example, if the surgical hub 5104 determines that theprocedure is utilizing insufflation because the insufflator 5110 isactivated, the surgical hub 5104 can then confirm that inference bydetecting whether the perioperative data from the smoke evacuator 5106likewise indicates that the body cavity is insufflated.

The combined energy generator 5112 supplies energy to one or moreultrasonic surgical instruments or RF electrosurgical instrumentsconnected thereto. The perioperative data that can be received by thesurgical hub 5104 from the combined energy generator 5112 can include,for example, the mode that the combined energy generator 5112 is set to(e.g., a vessel sealing mode or a cutting/coagulation mode). Thecontextual information that can be derived by the surgical hub 5104 fromthe perioperative data transmitted by the combined energy generator 5112can include, for example, the surgical procedural type (based on thenumber and types of surgical instruments that are connected to theenergy generator 5112) and the procedural step that is being performed(because the particular surgical instrument being utilized or theparticular order in which the surgical instruments are utilizedcorresponds to different steps of the surgical procedure). Further, theinferences derived by the surgical hub 5104 can depend upon inferencesand/or perioperative data previously received by the surgical hub 5104.Once the surgical hub 5104 has determined the general category orspecific type of surgical procedure being performed, the surgical hub5104 can determine or retrieve an expected sequence of steps for thesurgical procedure and then track the surgeon's progression through thesurgical procedure by comparing the detected sequence in which thesurgical instruments are utilized relative to the expected sequence.

The perioperative data that can be received by the surgical hub 5104from the ventilator 5118 can include, for example, the respiration rateand airway volume of the patient. The contextual information that can bederived by the surgical hub 5104 from the perioperative data transmittedby the ventilator 5118 can include, for example, whether the patient isunder anesthesia and whether the patient's lung is deflated. In someexemplifications, certain contextual information can be inferred by thesurgical hub 5104 based on combinations of perioperative data frommultiple data sources 5126. For example, the situational awarenesssystem of the surgical hub 5104 can be configured to infer that thepatient is under anesthesia when the respiration rate detected by theventilator 5118, the blood pressure detected by the BP monitor 5116, andthe heart rate detected by the EKG monitor 5120 fall below particularthresholds. For certain contextual information, the surgical hub 5104can be configured to only derive a particular inference when theperioperative data from a certain number or all of the relevant datasources 5126 satisfy the conditions for the inference.

As can be seen from the particular exemplified surgical system 5100, thesituational awareness system of a surgical hub 5104 can derive a varietyof contextual information regarding the surgical procedure beingperformed from the data sources 5126. The surgical hub 5104 can utilizethe derived contextual information to control the modular devices 5102and make further inferences about the surgical procedure in combinationwith data from other data sources 5126. It should be noted that theinferences depicted in FIG. 83A and described in connection with thedepicted surgical system 5100 are merely exemplary and should not beinterpreted as limiting in any way. Furthermore, the surgical hub 5104can be configured to derive a variety of other inferences from the same(or different) modular devices 5102 and/or patient monitoring devices5124. In other exemplifications, a variety of other modular devices 5102and/or patient monitoring devices 5124 can be paired to the surgical hub5104 in the operating theater and data received from those additionalmodular devices 5102 and/or patient monitoring devices 5124 can beutilized by the surgical hub 5104 to derive the same or differentcontextual information about the particular surgical procedure beingperformed.

FIGS. 84A-J depict logic flow diagrams for processes for deriving 5008a, 5008 b, 5008 c, 5008 d contextual information from various modulardevices, as discussed above with respect to the processes 5000 a, 5000b, 5000 c, 5000 d depicted in FIGS. 82A-D. The derived contextualinformation in FIGS. 84A-C is the procedure type. The procedure type cancorrespond to techniques utilized during the surgical procedure (e.g., asegmentectomy), the category of the surgical procedure (e.g., alaparoscopic procedure), the organ, tissue, or other structure beingoperated on, and other characteristics to identify the particularsurgical procedure (e.g., the procedure utilizes insufflation). Thederived contextual information in FIGS. 84D-G is the particular step ofthe surgical procedure that is being performed. The derived contextualinformation in FIGS. 84H-J is the patient's status. It can be noted thatthe patient's status can also correspond to the particular step of thesurgical procedure that is being performed (e.g., determining that thepatient's status has changed from not being under anesthesia to beingunder anesthesia can indicate that the step of the surgical procedure ofplacing the patient under anesthesia was carried out by the surgicalstaff). As with the process 5000 a depicted in FIG. 82A, the processesillustrated in FIGS. 84A-J can, in one exemplification, be executed by acontrol circuit of the surgical hub 5104. In the following descriptionsof the processes illustrated in FIGS. 84A-J, reference should also bemade to FIG. 83A.

FIG. 84A illustrates a logic flow diagram of a process 5111 fordetermining a procedure type according to smoke evacuator 5106perioperative data. In this exemplification, the control circuit of thesurgical hub 5104 executing the process 5111 receives 5113 perioperativedata from the smoke evacuator 5106 and then determines 5115 whether thesmoke evacuator 5106 is activated based thereon. If the smoke evacuator5106 is not activated, then the process 5111 continues along the NObranch and the control circuit of the surgical hub 5104 continuesmonitoring for the receipt of smoke evacuator 5106 perioperative data.If the smoke evacuator 5106 is activated, then the process 5111continues along the YES branch and the control circuit of the surgicalhub 5104 determines 5117 whether there is a pressure differentialbetween an internal upstream pressure sensor P₃ (FIG. 83B) and anexternal or ambient pressure sensor P₁ (FIG. 83B). If there is apressure differential (i.e., the internal upstream pressure of the smokeevacuator 5106 is greater then the ambient pressure of the operatingtheater), then the process 5111 continues along the YES branch and thecontrol circuit determines 5119 that the surgical procedure is aninsufflation-utilizing procedure. If there is not a pressuredifferential, then the process 5111 continues along the NO branch andthe control circuit determines 5121 that the surgical procedure is notan insufflation-utilizing procedure.

FIG. 84B illustrates a logic flow diagram of a process 5123 fordetermining a procedure type according to smoke evacuator 5106,insufflator 5110, and medical imaging device 5108 perioperative data. Inthis exemplification, the control circuit of the surgical hub 5104executing the process 5123 receives 5125, 5127, 5129 perioperative datafrom the smoke evacuator 5106, insufflator 5110, and medical imagingdevice 5108 and then determines 5131 whether all of the devices areactivated or paired with the surgical hub 5104. If all of these devicesare not activated or paired with the surgical hub 5104, then the process5123 continues along the NO branch and the control circuit determines5133 that the surgical procedure is not a VATS procedure. If all of theaforementioned devices are activated or paired with the surgical hub5104, then the process 5123 continues along the YES branch and thecontrol circuit determines 5135 that the surgical procedure is a VATSprocedure. The control circuit can make this determination based uponthe fact that al of these devices are required for a VATS procedure;therefore, if not all of these devices are being utilized in thesurgical procedure, it cannot be a VATS procedure.

FIG. 84C illustrates a logic flow diagram of a process 5137 fordetermining a procedure type according to medical imaging device 5108perioperative data. In this exemplification, the control circuit of thesurgical hub 5104 executing the process 5137 receives 5139 perioperativedata from the medical imaging device 5108 and then determines 5141whether the medical imaging device 5108 is transmitting an image orvideo feed. If the medical imaging device 5108 is not transmitting animage or video feed, then the process 5137 continues along the NO branchand the control circuit determines 5143 that the surgical procedure isnot a VATS procedure. If the medical imaging device 5108 is nottransmitting an image or video feed, then the process 5137 continuesalong the YES branch and the control circuit determines 5145 that thesurgical procedure is a VATS procedure. In one exemplification, thecontrol circuit of the surgical hub 5104 can execute the process 5137depicted in FIG. 84C in combination with the process 5123 depicted inFIG. 84B in order to confirm or increase the confidence in thecontextual information derived by both processes 5123, 5137. If there isa discontinuity between the determinations of the processes 5123, 5137(e.g., the medical imaging device 5108 is transmitting a feed, but notall of the requisite devices are paired with the surgical hub 5104),then the surgical hub 5104 can execute additional processes to come to afinal determination that resolves the discontinuities between theprocesses 5123, 5137 or display an alert or feedback to the surgicalstaff as to the discontinuity.

FIG. 84D illustrates a logic flow diagram of a process 5147 fordetermining a procedural step according to insufflator 5110perioperative data. In this exemplification, the control circuit of thesurgical hub 5104 executing the process 5147 receives 5149 perioperativedata from the insufflator 5110 and then determines 5151 whether there isa pressure differential between the surgical site and the ambientenvironment of the operating theater. In one exemplification, theinsufflator 5110 perioperative data can include a surgical site pressure(e.g., the intra-abdominal pressure) sensed by a first pressure sensorassociated with the insufflator 5110, which can be compared against apressure sensed by a second pressure sensor configured to detect theambient pressure. The first pressure sensor can be configured to detectan intra-abdominal pressure between 0-10 mmHg, for example. If there isa pressure differential, then the process 5147 continues along the YESbranch and the control circuit determines 5153 that aninsufflation-utilizing step of the surgical procedure is beingperformed. If there is not a pressure differential, then the process5147 continues along the NO branch and the control circuit determines5155 that an insufflation-utilizing step of the surgical procedure isnot being performed.

FIG. 84E illustrates a logic flow diagram of a process 5157 fordetermining a procedural step according to energy generator 5112perioperative data. In this exemplification, the control circuit of thesurgical hub 5104 executing the process 5157 receives 5159 perioperativedata from the energy generator 5112 and then determines 5161 whether theenergy generator 5112 is in the sealing mode. In variousexemplifications, the energy generator 5112 can include two modes: asealing mode corresponding to a first energy level and a cut/coagulationmode corresponding to a second energy level. If the energy generator5112 is not in the sealing mode, then the process 5157 proceeds alongthe NO branch and the control circuit determines 5163 that a dissectionstep of the surgical procedure is being performed. The control circuitcan make this determination 5163 because if the energy generator 5112 isnot on the sealing mode, then it must thus be on the cut/coagulationmode for energy generators 5112 having two modes of operation. Thecut/coagulation mode of the energy generator 5112 corresponds to adissection procedural step because it provides an appropriate degree ofenergy to the ultrasonic surgical instrument or RF electrosurgicalinstrument to dissect tissue. If the energy generator 5112 is in thesealing mode, then the process 5157 proceeds along the YES branch andthe control circuit determines 5165 that a ligation step of the surgicalprocedure is being performed. The sealing mode of the energy generator5112 corresponds to a ligation procedural step because it provides anappropriate degree of energy to the ultrasonic surgical instrument or RFelectrosurgical instrument to ligate vessels.

FIG. 84F illustrates a logic flow diagram of a process 5167 fordetermining a procedural step according to energy generator 5112perioperative data. In various aspects, previously receivedperioperative data and/or previously derived contextual information canalso be considered by processes in deriving subsequent contextualinformation. This allows the situational awareness system of thesurgical hub 5104 to derive additional and/or increasingly detailedcontextual information about the surgical procedure as the procedure isperformed. In this exemplification, the process 5167 determines 5169that a segmentectomy procedure is being performed. This contextualinformation can be derived by this process 5167 or other processes basedupon other received perioperative data and/or retrieved from a memory.Subsequently, the control circuit receives 5171 perioperative data fromthe energy generator 5112 indicating that a surgical instrument is beingfired and then determines 5173 whether the energy generator 5112 wasutilized in a previous step of the procedure to fire the surgicalinstrument. The control circuit can determine 5173 whether the energygenerator 5112 was previously utilized in a prior step of the procedureby retrieving a list of the steps that have been performed in thecurrent surgical procedure from a memory, for example. In suchexemplifications, when the surgical hub 5104 determines that a step ofthe surgical procedure has been performed or completed by the surgicalstaff, the surgical hub 5104 can update a list of the procedural stepsthat have been performed, which can then be subsequently retrieved bythe control circuit of the surgical hub 5104. In one exemplification,the surgical hub 5104 can distinguish between sequences of firings ofthe surgical instrument as corresponding to separate steps of thesurgical procedure according to the time delay between the sequences offirings, whether any intervening actions were taken or modular devices5102 were utilized by the surgical staff, or other factors that thesituational awareness system can detect. If the energy generator 5112has not been previously utilized during the course of the segmentectomyprocedure, the process 5167 proceeds along the NO branch and the controlcircuit determines 5175 that the step of dissecting tissue to mobilizethe patient's lungs is being performed by the surgical staff. If theenergy generator 5112 has been previously utilized during the course ofthe segmentectomy procedure, the process 5167 proceeds along the YESbranch and the control circuit determines 5177 that the step ofdissecting nodes is being performed by the surgical staff. An ultrasonicsurgical instrument or RF electrosurgical instrument is utilized twiceduring the course of an example of a segmentectomy procedure (e.g., FIG.86 ); therefore, the situational awareness system of the surgical hub5104 executing the process 5167 can distinguish between which step theutilization of the energy generator 5112 indicates is currently beingperformed based upon whether the energy generator 5112 was previouslyutilized.

FIG. 84G illustrates a logic flow diagram of a process 5179 fordetermining a procedural step according to stapler perioperative data.As described above with respect to the process 5167 illustrated in FIG.84F, the process 5179 utilizes previously received perioperative dataand/or previously derived contextual information in deriving subsequentcontextual information. In this exemplification, the process 5179determines 5181 that a segmentectomy procedure is being performed. Thiscontextual information can be derived by this process 5179 or otherprocesses based upon other received perioperative data and/or retrievedfrom a memory. Subsequently, the control circuit receives 5183perioperative data from the surgical stapling instrument (i.e., stapler)indicating that the surgical stapling instrument is being fired and thendetermines 5185 whether the surgical stapling instrument was utilized ina previous step of the surgical procedure. As described above, thecontrol circuit can determine 5185 whether the surgical staplinginstrument was previously utilized in a prior step of the procedure byretrieving a list of the steps that have been performed in the currentsurgical procedure from a memory, for example. If the surgical staplinginstrument has not been utilized previously, then the process 5179proceeds along the NO branch and the control circuit determines 5187that the step of ligating arteries and veins is being performed by thesurgical staff. If the surgical stapling instrument has been previouslyutilized during the course of the segmentectomy procedure, the process5179 proceeds along the YES branch and the control circuit determines5189 that the step of transecting parenchyma is being performed by thesurgical staff. A surgical stapling instrument is utilized twice duringthe course of an example of a segmentectomy procedure (e.g., FIG. 86 );therefore, the situational awareness system of the surgical hub 5104executing the process 5179 can distinguish between which step theutilization of the surgical stapling instrument indicates is currentlybeing performed based upon whether the surgical stapling instrument waspreviously utilized.

FIG. 84H illustrates a logic flow diagram of a process 5191 fordetermining a patient status according to ventilator 5110, pulseoximeter 5114, BP monitor 5116, and/or EKG monitor 5120 perioperativedata. In this exemplification, the control circuit of the surgical hub5104 executing the process 5191 receives 5193, 5195, 5197, 5199perioperative data from each of the ventilator 5110, pulse oximeter5114, BP monitor 5116, and/or EKG monitor 5120 and then determineswhether one or more values of the physiological parameters sensed byeach of the devices fall below a threshold for each of the physiologicalparameters. The threshold for each physiological parameter cancorrespond to a value that corresponds to a patient being underanesthesia. In other words, the control circuit determines 5201 whetherthe patient's respiration rate, oxygen saturation, blood pressure,and/or heart rate indicate that the patient is under anesthesiaaccording data sensed by the respective modular device 5102 and/orpatient monitoring devices 5124. In one exemplification, if the all ofthe values from the perioperative data are below their respectivethresholds, then the process 5191 proceeds along the YES branch and thecontrol circuit determines 5203 that the patient is under anesthesia. Inanother exemplification, the control circuit can determine 5203 that thepatient is under anesthesia if a particular number or ratio of themonitored physiological parameters indicate that the patient is underanesthesia. Otherwise, the process 5191 proceeds along the NO branch andthe control circuit determines 5205 that the patient is not underanesthesia.

FIG. 841 illustrates a logic flow diagram of a process 5207 fordetermining a patient status according to pulse oximeter 5114, BPmonitor 5116, and/or EKG monitor 5120 perioperative data. In thisexemplification, the control circuit of the surgical hub 5104 executingthe process 5207 receives 5209, 5211, 5213 (or attempts to receive)perioperative data the pulse oximeter 5114, BP monitor 5116, and/or EKGmonitor 5120 and then determines 5215 whether at least one of thedevices is paired with the surgical hub 5104 or the surgical hub 5104 isotherwise receiving data therefrom. If the control circuit is receivingdata from at least one of these patient monitoring devices 5124, theprocess 5207 proceeds along the YES branch and the control circuitdetermines 5217 that the patient is in the operating theater. Thecontrol circuit can make this determination because the patientmonitoring devices 5214 connected to the surgical hub 5104 must be inthe operating theater and thus the patient must likewise be in theoperating theater. If the control circuit is not receiving data from atleast one of these patient monitoring devices 5124, the process 5207proceeds along the NO branch and the control circuit determines 5219that the patient is not in the operating theater.

FIG. 84J illustrates a logic flow diagram of a process 5221 fordetermining a patient status according to ventilator 5110 perioperativedata. In this exemplification, the control circuit of the surgical hub5104 executing the process 5221 receives 5223 perioperative data fromthe ventilator 5110 and then determines 5225 whether the patient'sairway volume has decreased or is decreasing. In one exemplification,the control circuit determines 5225 whether the patient's airway volumefalls below a particular threshold value indicative of a lung havingcollapsed or been deflated. In another exemplification, the controlcircuit determines 5225 whether the patient's airway volume falls belowan average or baseline level by a threshold amount. If the patient'sairway volume has not decreased sufficiently, the process 5221 proceedsalong the NO branch and the control circuit determines 5227 that thepatient's lung is not deflated. If the patient's airway volume hasdecreased sufficiently, the process 5221 proceeds along the YES branchand the control circuit determines 5229 that the patient's lung is notdeflated.

In one exemplification, the surgical system 5100 can further includevarious scanners that can be paired with the surgical hub 5104 to detectand record objects and individuals that enter and exit the operatingtheater. FIG. 85A illustrates a scanner 5128 paired with a surgical hub5104 that is configured to scan a patient wristband 5130. In one aspect,the scanner 5128 includes, for example, a barcode reader or aradio-frequency identification (RFID) reader that is able to readpatient information from the patient wristband 5130 and then transmitthat information to the surgical hub 5104. The patient information caninclude the surgical procedure to be performed or identifyinginformation that can be cross-referenced with the hospital's EMRdatabase 5122 by the surgical hub 5104, for example. FIG. 85Billustrates a scanner 5132 paired with a surgical hub 5104 that isconfigured to scan a product list 5134 for a surgical procedure. Thesurgical hub 5104 can utilize data from the scanner 5132 regarding thenumber, type, and mix of items to be used in the surgical procedure toidentify the type of surgical procedure being performed. In oneexemplification, the scanner 5132 includes a product scanner (e.g., abarcode reader or an RFID reader) that is able to read the productinformation (e.g., name and quantity) from the product itself or theproduct packaging as the products are brought into the operating theaterand then transmit that information to the surgical hub 5104. In anotherexemplification, the scanner 5132 includes a camera (or othervisualization device) and associated optical character recognitionsoftware that is able to read the product information from a productlist 5134. The surgical hub 5104 can be configured to cross-referencethe list of items indicated by the received data with a lookup table ordatabase of items utilized for various types of surgical procedures inorder to infer the particular surgical procedure that is to be (or was)performed. As shown in FIG. 85B, the illustrative product list 5134includes ring forceps, rib spreaders, a powered vascular stapler (PVS),and a thoracic wound protector. In this example, the surgical hub 5104can infer that the surgical procedure is a thoracic procedure from thisdata since these products are only utilized in thoracic procedures. Insum, the scanner(s) 5128, 5132 can provide serial numbers, productlists, and patient information to the surgical hub 5104. Based on thisdata regarding what devices and instruments are being utilized and thepatient's medical information, the surgical hub 5104 can determineadditional contextual information regarding the surgical procedure.

In order to assist in the understanding of the process 5000 aillustrated in FIG. 82A and the other concepts discussed above, FIG. 86illustrates a timeline 5200 of an illustrative surgical procedure andthe contextual information that a surgical hub 5104 can derive from thedata received from the data sources 5126 at each step in the surgicalprocedure. In the following description of the timeline 5200 illustratedin FIG. 86 , reference should also be made to FIG. 81 . The timeline5200 depicts the typical steps that would be taken by the nurses,surgeons, and other medical personnel during the course of a lungsegmentectomy procedure, beginning with setting up the operating theaterand ending with transferring the patient to a post-operative recoveryroom. The situationally aware surgical hub 5104 receives data from thedata sources 5126 throughout the course of the surgical procedure,including data generated each time medical personnel utilize a modulardevice 5102 that is paired with the surgical hub 5104. The surgical hub5104 can receive this data from the paired modular devices 5102 andother data sources 5126 and continually derive inferences (i.e.,contextual information) about the ongoing procedure as new data isreceived, such as which step of the procedure is being performed at anygiven time. The situational awareness system of the surgical hub 5104 isable to, for example, record data pertaining to the procedure forgenerating reports (e.g., see FIGS. 90-101 ), verify the steps beingtaken by the medical personnel, provide data or prompts (e.g., via adisplay screen) that may be pertinent for the particular proceduralstep, adjust modular devices 5102 based on the context (e.g., activatemonitors, adjust the FOV of the medical imaging device, or change theenergy level of an ultrasonic surgical instrument or RF electrosurgicalinstrument), and take any other such action described above.

As the first step 5202 in this illustrative procedure, the hospitalstaff members retrieve the patient's EMR from the hospital's EMRdatabase. Based on select patient data in the EMR, the surgical hub 5104determines that the procedure to be performed is a thoracic procedure.Second 5204, the staff members scan the incoming medical supplies forthe procedure. The surgical hub 5104 cross-references the scannedsupplies with a list of supplies that are utilized in various types ofprocedures and confirms that the mix of supplies corresponds to athoracic procedure (e.g., as depicted in FIG. 85B). Further, thesurgical hub 5104 is also able to determine that the procedure is not awedge procedure (because the incoming supplies either lack certainsupplies that are necessary for a thoracic wedge procedure or do nototherwise correspond to a thoracic wedge procedure). Third 5206, themedical personnel scan the patient band (e.g., as depicted in FIG. 85A)via a scanner 5128 that is communicably connected to the surgical hub5104. The surgical hub 5104 can then confirm the patient's identitybased on the scanned data. Fourth 5208, the medical staff turns on theauxiliary equipment. The auxiliary equipment being utilized can varyaccording to the type of surgical procedure and the techniques to beused by the surgeon, but in this illustrative case they include a smokeevacuator, insufflator, and medical imaging device. When activated, theauxiliary equipment that are modular devices 5102 can automatically pairwith the surgical hub 5104 that is located within a particular vicinityof the modular devices 5102 as part of their initialization process. Thesurgical hub 5104 can then derive contextual information about thesurgical procedure by detecting the types of modular devices 5102 thatpair with it during this pre-operative or initialization phase. In thisparticular example, the surgical hub 5104 determines that the surgicalprocedure is a VATS procedure based on this particular combination ofpaired modular devices 5102. Based on the combination of the data fromthe patient's EMR, the list of medical supplies to be used in theprocedure, and the type of modular devices 5102 that connect to the hub,the surgical hub 5104 can generally infer the specific procedure thatthe surgical team will be performing. Once the surgical hub 5104 knowswhat specific procedure is being performed, the surgical hub 5104 canthen retrieve the steps of that procedure from a memory or from thecloud and then cross-reference the data it subsequently receives fromthe connected data sources 5126 (e.g., modular devices 5102 and patientmonitoring devices 5124) to infer what step of the surgical procedurethe surgical team is performing. Fifth 5210, the staff members attachthe EKG electrodes and other patient monitoring devices 5124 to thepatient. The EKG electrodes and other patient monitoring devices 5124are able to pair with the surgical hub 5104. As the surgical hub 5104begins receiving data from the patient monitoring devices 5124, thesurgical hub 5104 thus confirms that the patient is in the operatingtheater, as described in the process 5207 depicted in FIG. 84I, forexample. Sixth 5212, the medical personnel induce anesthesia in thepatient. The surgical hub 5104 can infer that the patient is underanesthesia based on data from the modular devices 5102 and/or patientmonitoring devices 5124, including EKG data, blood pressure data,ventilator data, or combinations thereof, as described in the process5191 depicted in FIG. 84H, for example. Upon completion of the sixthstep 5212, the pre-operative portion of the lung segmentectomy procedureis completed and the operative portion begins.

Seventh 5214, the patient's lung that is being operated on is collapsed(while ventilation is switched to the contralateral lung). The surgicalhub 5104 can infer from the ventilator data that the patient's lung hasbeen collapsed, as described in the process 5221 depicted in FIG. 84J,for example. The surgical hub 5104 can infer that the operative portionof the procedure has commenced as it can compare the detection of thepatient's lung collapsing to the expected steps of the procedure (whichcan be accessed or retrieved previously) and thereby determine thatcollapsing the lung is the first operative step in this particularprocedure. Eighth 5216, the medical imaging device 5108 (e.g., a scope)is inserted and video from the medical imaging device is initiated. Thesurgical hub 5104 receives the medical imaging device data (i.e., videoor image data) through its connection to the medical imaging device.Upon receipt of the medical imaging device data, the surgical hub 5104can determine that the laparoscopic portion of the surgical procedurehas commenced. Further, the surgical hub 5104 can determine that theparticular procedure being performed is a segmentectomy, as opposed to alobectomy (note that a wedge procedure has already been discounted bythe surgical hub 5104 based on data received at the second step 5204 ofthe procedure). The data from the medical imaging device 124 (FIG. 2 )can be utilized to determine contextual information regarding the typeof procedure being performed in a number of different ways, including bydetermining the angle at which the medical imaging device is orientedwith respect to the visualization of the patient's anatomy, monitoringthe number or medical imaging devices being utilized (i.e., that areactivated and paired with the surgical hub 5104), and monitoring thetypes of visualization devices utilized. For example, one technique forperforming a VATS lobectomy places the camera in the lower anteriorcorner of the patient's chest cavity above the diaphragm, whereas onetechnique for performing a VATS segmentectomy places the camera in ananterior intercostal position relative to the segmental fissure. Usingpattern recognition or machine learning techniques, for example, thesituational awareness system can be trained to recognize the positioningof the medical imaging device according to the visualization of thepatient's anatomy. As another example, one technique for performing aVATS lobectomy utilizes a single medical imaging device, whereas anothertechnique for performing a VATS segmentectomy utilizes multiple cameras.As yet another example, one technique for performing a VATSsegmentectomy utilizes an infrared light source (which can becommunicably coupled to the surgical hub as part of the visualizationsystem) to visualize the segmental fissure, which is not utilized in aVATS lobectomy. By tracking any or all of this data from the medicalimaging device 5108, the surgical hub 5104 can thereby determine thespecific type of surgical procedure being performed and/or the techniquebeing used for a particular type of surgical procedure.

Ninth 5218, the surgical team begins the dissection step of theprocedure. The surgical hub 5104 can infer that the surgeon is in theprocess of dissecting to mobilize the patient's lung because it receivesdata from the RF or ultrasonic generator indicating that an energyinstrument is being fired. The surgical hub 5104 can cross-reference thereceived data with the retrieved steps of the surgical procedure todetermine that an energy instrument being fired at this point in theprocess (i.e., after the completion of the previously discussed steps ofthe procedure) corresponds to the dissection step. Tenth 5220, thesurgical team proceeds to the ligation step of the procedure. Thesurgical hub 5104 can infer that the surgeon is ligating arteries andveins because it receives data from the surgical stapling and cuttinginstrument indicating that the instrument is being fired. Similarly tothe prior step, the surgical hub 5104 can derive this inference bycross-referencing the receipt of data from the surgical stapling andcutting instrument with the retrieved steps in the process. Eleventh5222, the segmentectomy portion of the procedure is performed. Thesurgical hub 5104 can infer that the surgeon is transecting theparenchyma based on data from the surgical stapling and cuttinginstrument, including data from its cartridge. The cartridge data cancorrespond to the size or type of staple being fired by the instrument,for example. As different types of staples are utilized for differenttypes of tissues, the cartridge data can thus indicate the type oftissue being stapled and/or transected. In this case, the type of staplebeing fired is utilized for parenchyma (or other similar tissue types),which allows the surgical hub 5104 to infer that the segmentectomyportion of the procedure is being performed. Twelfth 5224, the nodedissection step is then performed. The surgical hub 5104 can infer thatthe surgical team is dissecting the node and performing a leak testbased on data received from the generator indicating that an RF orultrasonic instrument is being fired. For this particular procedure, anRF or ultrasonic instrument being utilized after parenchyma wastransected corresponds to the node dissection step, which allows thesurgical hub 5104 to make this inference. It should be noted thatsurgeons regularly switch back and forth between surgicalstapling/cutting instruments and surgical energy (i.e., RF orultrasonic) instruments depending upon the particular step in theprocedure because different instruments are better adapted forparticular tasks. Therefore, the particular sequence in which thestapling/cutting instruments and surgical energy instruments are usedcan indicate what step of the procedure the surgeon is performing. Uponcompletion of the twelfth step 5224, the incisions and closed up and thepost-operative portion of the procedure begins.

Thirteenth 5226, the patient's anesthesia is reversed. The surgical hub5104 can infer that the patient is emerging from the anesthesia based onthe ventilator data (i.e., the patient's breathing rate beginsincreasing), for example. Lastly, the fourteenth step 5228 is that themedical personnel remove the various patient monitoring devices 5124from the patient. The surgical hub 5104 can thus infer that the patientis being transferred to a recovery room when the hub loses EKG, BP, andother data from the patient monitoring devices 5124. As can be seen fromthe description of this illustrative procedure, the surgical hub 5104can determine or infer when each step of a given surgical procedure istaking place according to data received from the various data sources5126 that are communicably coupled to the surgical hub 5104.

In addition to utilizing the patient data from EMR database(s) to inferthe type of surgical procedure that is to be performed, as illustratedin the first step 5202 of the timeline 5200 depicted in FIG. 86 , thepatient data can also be utilized by a situationally aware surgical hub5104 to generate control adjustments for the paired modular devices5102. FIG. 87A illustrates a flow diagram depicting the process 5240 ofimporting patient data stored in an EMR database 5250 and derivinginferences 5256 therefrom, in accordance with at least one aspect of thepresent disclosure. Further, FIG. 87B illustrates a flow diagramdepicting the process 5242 of determining control adjustments 5264corresponding to the derived inferences 5256 from FIG. 87A, inaccordance with at least one aspect of the present disclosure. In thefollowing description of the processes 5240, 5242, reference should alsobe made to FIG. 81 .

As shown in FIG. 87A, the surgical hub 5104 retrieves the patientinformation (e.g., EMR) stored in a database 5250 to which the surgicalhub 5104 is communicably connected. The unredacted portion of thepatient data is removed 5252 from the surgical hub 5104, leavinganonymized, stripped patient data 5254 related to the patient'scondition and/or the surgical procedure to be performed. The unredactedpatient data is removed 5252 in order to maintain patient anonymity forthe processing of the data (including if the data is uploaded to thecloud for processing and/or data tracking for reports). The strippedpatient data 5254 can include any medical conditions that the patient issuffering from, the patient's medical history (including previoustreatments or procedures), medication that the patient is taking, andother such medically relevant details. The control circuit of thesurgical hub 5104 can then derive various inferences 5256 from thestripped patient data 5254, which can in turn be utilized by thesurgical hub 5104 to derive various control adjustments for the pairedmodular devices 5102. The derived inferences 5256 can be based uponindividual pieces of data or combinations of pieces of data. Further,the derived inferences 5256 may, in some cases, be redundant with eachother as some data may lead to the same inference. By integrating eachpatient's stripped patient data 5254 into the situational awarenesssystem, the surgical hub 5104 is thus able to generate pre-procedureadjustments to optimally control each of the modular devices 5102 basedon the unique circumstances associated with each individual patient. Inthe illustrated example, the stripped patient data 5254 includes that(i) the patient is suffering from emphysema, (ii) has high bloodpressure, (iii) is suffering from a small cell lung cancer, (iv) istaking warfarin (or another blood thinner), and/or (v) has receivedradiation pretreatment. In the illustrated example, the inferences 5256derived from the stripped patient data 5254 include that (i) the lungtissue will be more fragile than normal lung tissue, (ii) hemostasisissues are more likely, (iii) the patient is suffering from a relativelyaggressive cancer, (iv) hemostasis issues are more likely, and (v) thelung tissue will be stiffer and more prone to fracture, respectively.

After the control circuit of the surgical hub 5104 receives oridentifies the implications 5256 that are derived from anonymizedpatient data, the control circuit of the surgical hub 5104 is configuredto execute a process 5242 to control the modular devices 5102 in amanner consistent with the derived implications 5256. In the exampleshown in FIG. 87B, the control circuit of the surgical hub 5104interprets how the derived implications 5256 impacts the modular devices5102 and then communicates corresponding control adjustments to each ofthe modular devices 5102. In the example shown in FIG. 87B, the controladjustments include (i) adjusting the compression rate thresholdparameter of the surgical stapling and cutting instrument, (ii)adjusting the visualization threshold value of the surgical hub 5104 toquantify bleeding via the visualization system 108 (FIG. 2 ) (thisadjustment can apply to the visualization system 108 itself or as aninternal parameter of the surgical hub 5104), (iii) adjusts the powerand control algorithms of the combo generator module 140 (FIG. 3 ) forthe lung tissue and vessel tissue types, (iv) adjusts the margin rangesof the medical imaging device 124 (FIG. 2 ) to account for theaggressive cancer type, (v) notifies the surgical stapling and cuttinginstrument of the margin parameter adjustment needed (the marginparameter corresponds to the distance or amount of tissue around thecancer that will be excised), and (vi) notifies the surgical staplingand cutting instrument that the tissue is potentially fragile, whichcauses the control algorithm of the surgical stapling and cuttinginstrument to adjust accordingly. Furthermore, the data regarding theimplications 5256 derived from the anonymized patient data 5254 isconsidered by the situational awareness system to infer contextualinformation 5260 regarding the surgical procedure being performed. Inthe example shown in FIG. 87B, the situational awareness system furtherinfers that the procedure is a thoracic lung resection 5262, e.g.,segmentectomy.

Determining where inefficiencies or ineffectiveness may reside in amedical facility's practice can be challenging because medicalpersonnel's efficiency in completing a surgical procedure, correlatingpositive patient outcomes with particular surgical teams or particulartechniques in performing a type of surgical procedure, and otherperformance measures are not easily quantified using legacy systems. Asone solution, the surgical hubs can be employed to track and store datapertaining to the surgical procedures that the surgical hubs are beingutilized in connection with and generate reports or recommendationsrelated to the tracked data. The tracked data can include, for example,the length of time spent during a particular procedure, the length oftime spent on a particular step of a particular procedure, the length ofdowntime between procedures, modular device(s) (e.g., surgicalinstruments) utilized during the course of a procedure, and the numberand type of surgical items consumed during a procedure (or stepthereof). Further, the tracked data can include, for example, theoperating theater in which the surgical hub is located, the medicalpersonnel associated with the particular event (e.g., the surgeon orsurgical team performing the surgical procedure), the day and time atwhich the particular event(s) occurred, and patient outcomes. This datacan be utilized to create performance metrics, which can be utilized todetect and then ultimately address inefficiencies or ineffectivenesswithin a medical facility's practice. In one exemplification, thesurgical hub includes a situational awareness system, as describedabove, that is configured to infer or determine information regarding aparticular event (e.g., when a particular step of a surgical procedureis being performed and/or how long the step took to complete) based ondata received from data sources connected to the surgical hub (e.g.,paired modular devices). The surgical hub can then store this trackeddata to provide reports or recommendations to users.

Aggregation and Reporting of Surgical Hub Data

FIG. 88 illustrates a block diagram of a computer-implementedinteractive surgical system 5700, in accordance with at least one aspectof the present disclosure. The system 5700 includes a number of surgicalhubs 5706 that, as described above, are able to detect and track datarelated to surgical procedures that the surgical hubs 5706 (and themodular devices paired to the surgical hubs 5706) are utilized inconnection with. In one exemplification, the surgical hubs 5706 areconnected to form local networks such that the data being tracked by thesurgical hubs 5706 is aggregated together across the network. Thenetworks of surgical hubs 5706 can be associated with a medicalfacility, for example. The data aggregated from the network of surgicalhubs 5706 can be analyzed to provide reports on data trends orrecommendations. For example, the surgical hubs 5706 of a first medicalfacility 5704 a are communicably connected to a first local database5708 a and the surgical hubs 5706 of a second medical facility 5704 bare communicably connected to a second local database 5708 b. Thenetwork of surgical hubs 5706 associated with the first medical facility5704 a can be distinct from the network of surgical hubs 5706 associatedwith the second medical facility 5704 b, such that the aggregated datafrom each network of surgical hubs 5706 corresponds to each medicalfacility 5704 a, 5704 b individually. A surgical hub 5706 or anothercomputer terminal communicably connected to the database 5708 a, 5708 bcan be configured to provide reports or recommendations based on theaggregated data associated with the respective medical facility 5704 a,5704 b. In this exemplification, the data tracked by the surgical hubs5706 can be utilized to, for example, report whether a particularincidence of a surgical procedure deviated from the average in-networktime to complete the particular procedure type.

In another exemplification, each surgical hub 5706 is configured toupload the tracked data to the cloud 5702, which then processes andaggregates the tracked data across multiple surgical hubs 5706, networksof surgical hubs 5706, and/or medical facilities 5704 a, 5704 b that areconnected to the cloud 5702. Each surgical hub 5706 can then be utilizedto provide reports or recommendations based on the aggregated data. Inthis exemplification, the data tracked by the surgical hubs 5706 can beutilized to, for example, report whether a particular incidence of asurgical procedure deviated from the average global time to complete theparticular procedure type.

In another exemplification, each surgical hub 5706 can further beconfigured to access the cloud 5702 to compare locally tracked data toglobal data aggregated from all of the surgical hubs 5706 that arecommunicably connected to the cloud 5702. Each surgical hub 5706 can beconfigured to provide reports or recommendations based on the comparisonbetween the tracked local data relative to local (i.e., in-network) orglobal norms. In this exemplification, the data tracked by the surgicalhubs 5706 can be utilized to, for example, report whether a particularincidence of a surgical procedure deviated from either the averagein-network time or the average global time to complete the particularprocedure type.

In one exemplification, each surgical hub 5706 or another computersystem local to the surgical hub 5706 is configured to locally aggregatethe data tracked by the surgical hubs 5706, store the tracked data, andgenerate reports and/or recommendations according to the tracked data inresponse to queries. In cases where the surgical hub 5706 is connectedto a medical facility network (which may include additional surgicalhubs 5706), the surgical hub 5706 can be configured to compare thetracked data with the bulk medical facility data. The bulk medicalfacility data can include EMR data and aggregated data from the localnetwork of surgical hubs 5706. In another exemplification, the cloud5702 is configured to aggregate the data tracked by the surgical hubs5706, store the tracked data, and generate reports and/orrecommendations according to the tracked data in response to queries.

Each surgical hub 5706 can provide reports regarding trends in the dataand/or provide recommendations on improving the efficiency oreffectiveness of the surgical procedures being performed. In variousexemplifications, the data trends and recommendations can be based ondata tracked by the surgical hub 5706 itself, data tracked across alocal medical facility network containing multiple surgical hubs 5706,or data tracked across a number of surgical hubs 5706 communicablyconnected to a cloud 5702. The recommendations provided by the surgicalhub 5706 can describe, for example, particular surgical instruments orproduct mixes to utilize for particular surgical procedures based oncorrelations between the surgical instruments/product mixes and patientoutcomes and procedural efficiency. The reports provided by the surgicalhub 5706 can describe, for example, whether a particular surgicalprocedure was performed efficiently relative to local or global norms,whether a particular type of surgical procedure being performed at themedical facility is being performed efficiently relative to globalnorms, and the average time taken to complete a particular surgicalprocedure or step of a surgical procedure for a particular surgicalteam.

In one exemplification, each surgical hub 5706 is configured todetermine when operating theater events occur (e.g., via a situationalawareness system) and then track the length of time spent on each event.An operating theater event is an event that a surgical hub 5706 candetect or infer the occurrence of. An operating theater event caninclude, for example, a particular surgical procedure, a step or portionof a surgical procedure, or downtime between surgical procedures. Theoperating theater events can be categorized according to an event type,such as a type of surgical procedure being performed, so that the datafrom individual procedures can be aggregated together to form searchabledata sets. FIG. 90 illustrates an example of a diagram 5400 depictingthe data tracked by the surgical hubs 5706 being parsed to provideincreasingly detailed metrics related to surgical procedures or the useof the surgical hub 5706 (as depicted further in FIGS. 91-95 ) for anillustrative data set. In one exemplification, the surgical hub 5706 isconfigured to determine whether a surgical procedure is being performedand then track both the length of time spent between procedures (i.e.,downtime) and the time spent on the procedures themselves. The surgicalhub 5706 can further be configured to determine and track the time spenton each of the individual steps taken by the medical personnel (e.g.,surgeons, nurses, orderlies) either between or during the surgicalprocedures. The surgical hub can determine when surgical procedures ordifferent steps of surgical procedures are being performed via asituational awareness system, which is described in further detailabove.

FIG. 89 illustrates a logic flow diagram of a process 5300 for trackingdata associated with an operating theater event. In the followingdescription, description of the process 5300, reference should also bemade to FIG. 88 . In one exemplification, the process 5300 can beexecuted by a control circuit of a surgical hub 206, as depicted in FIG.10 (processor 244). In yet another exemplification, the process 5300 canbe executed by a distributed computing system including a controlcircuit of a surgical hub 206 in combination with a control circuit of amodular device, such as the microcontroller 461 of the surgicalinstrument depicted FIG. 12 , the microcontroller 620 of the surgicalinstrument depicted in FIG. 16 , the control circuit 710 of the roboticsurgical instrument 700 depicted in FIG. 17 , the control circuit 760 ofthe surgical instruments 750, 790 depicted in FIGS. 18 and 19 , or thecontroller 838 of the generator 800 depicted in FIG. 20 . For economy,the following description of the process 5300 will be described as beingexecuted by the control circuit of a surgical hub 5706; however, itshould be understood that the description of the process 5300encompasses all of the aforementioned exemplifications.

The control circuit of the surgical hub 5706 executing the process 5300receives 5302 perioperative data from the modular devices and other datasources (e.g., databases and patient monitoring devices) that arecommunicably coupled to the surgical hub 5706. The control circuit thendetermines 5304 whether an event has occurred via, for example, asituational awareness system that derives contextual information fromthe received 5302 data. The event can be associated with an operatingtheater in which the surgical hub 5706 in being used. The event caninclude, for example, a surgical procedure, a step or portion of asurgical procedure, or downtime between surgical procedures or steps ofa surgical procedure. Furthermore, the control circuit tracks dataassociated with the particular event, such as the length of time of theevent, the surgical instruments and/or other medical products utilizedduring the course of the event, and the medical personnel associatedwith the event. The surgical hub 5706 can further determine thisinformation regarding the event via, for example, the situationalawareness system.

For example, the control circuit of a situationally aware surgical hub5706 could determine that anesthesia is being induced in a patientthrough data received from one or more modular devices 5102 (FIG. 81 )and/or patient monitoring devices 5124 (FIG. 81 ). The control circuitcould then determine that the operative portion of the surgicalprocedure has begun upon detecting that an ultrasonic surgicalinstrument or RF electrosurgical instrument has been activated. Thecontrol circuit could thus determine the length of time for theanesthesia inducement step according to the difference in time betweenthe beginning of that particular step and the beginning of the firststep in the operative portion of the surgical procedure. Likewise, thecontrol circuit could determine how long the particular operative stepin the surgical procedure took according to when the control circuitdetects the subsequent step in the procedure begins. Further, thecontrol circuit could determine how long the overall operative portionof the surgical procedure took according to when the control circuitdetects that the final operative step in the procedure ends. The controlcircuit can also determine what surgical instruments (and other modulardevices 5102) are being utilized during the course of each step in thesurgical procedure by tracking the activation and/or use of theinstruments during each of the steps. The control circuit can alsodetect the completion of the surgical procedure by, for example,detecting when the patient monitoring devices 5124 have been removedfrom the patient (as in step fourteen 5228 of FIG. 86 ). The controlcircuit can then track the downtime between procedures according to whenthe control circuit infers that the subsequent surgical procedure hasbegun.

The control circuit executing the process 5300 then aggregates 5306 thedata associated with the event according to the event type. In oneexemplification, the aggregated 5306 data can be stored in a memory 249(FIG. 10 ) of the surgical hub 5706. In another exemplification, thecontrol circuit is configured to upload the data associated with theevent to the cloud 5702, whereupon the data is aggregated 5306 accordingto the event type for all of the data uploaded by each of the surgicalhubs 5706 connected to the cloud 5702. In yet another exemplification,the control circuit is configured to upload the data associated with theevent to a database associated with a local network of the surgical hubs5706, whereupon the data is aggregated 5306 according to the event typefor all of the data uploaded across the local network of surgical hubs5706.

In one exemplification, the control circuit is further configured tocompare the data associated with the event type to baseline dataassociated with the event type. The baseline data can correspond to, forexample, average values associated with the particular event type for aparticular hospital, network of hospitals, or across the entirety of thecloud 5702. The baseline data can be stored on the surgical hub 5706 orretrieved by the surgical 5706 as the perioperative data is received5302 thereby.

Aggregating 5306 the data from each of the events according to the eventtype allows individual incidents of the event type to thereafter becompared against the historical or aggregated data to determine whendeviations from the norm for an event type occur. The control circuitfurther determines 5308 whether it has received a query. If the controlcircuit does not receive a query, then the process 5300 continues alongthe NO branch and loops back to continue receiving 5302 data from thedata sources. If the control circuit does receive a query for aparticular event type, the process 5300 continues along the YES branchand the control circuit then retrieves the aggregated data for theparticular event type and displays 5310 the appropriate aggregated datacorresponding to the query. In various exemplifications, the controlcircuit can retrieve the appropriate aggregated data from the memory ofthe surgical hub 5706, the cloud 5702, or a local database 5708 a, 5708b.

In one example, the surgical hub 5706 is configured to determine alength of time for a particular procedure via the aforementionedsituational awareness system according to data received from one or moremodular devices utilized in the performance of the surgical procedure(and other data sources). Each time a surgical procedure is completed,the surgical hub 5706 uploads or stores the length of time required tocomplete the particular type of surgical procedure, which is thenaggregated with the data from every other instance of the type ofprocedure. In some aspects, the surgical hub 5706, cloud 5702, and/orlocal database 5708 a, 5708 b can then determine an average or expectedprocedure length for the particular type of procedure from theaggregated data. When the surgical hub 5706 receives a query as to theparticular type of procedure thereafter, the surgical hub 5706 can thenprovide feedback as to the average (or expected) procedure length orcompare an individual incidence of the procedure type to the averageprocedure length to determine whether the particular incidence deviatestherefrom.

In some aspects, the surgical hub 5706 can be configured toautomatically compare each incidence of an event type to average orexpected norms for the event type and then provide feedback (e.g.,display a report) when a particular incidence of the event type deviatesfrom the norm. For example, the surgical hub 5706 can be configured toprovide feedback whenever a surgical procedure (or a step of thesurgical procedure) deviates from the expected length of time tocomplete the surgical procedure (or the step of the surgical procedure)by more than a set amount.

Referring back to FIG. 90 , the surgical hub 5706 could be configured totrack, store, and display data regarding the number of patients operatedon (or procedures completed) per day per operating theater (bar graph5402 depicted further in FIG. 91 ), for example. The surgical hub 5706could be configured to further parse the number of patients operated on(or procedures completed) per day per operating theater and can befurther parsed according to the downtime between the procedures on agiven day (bar graph 5404 depicted further in FIG. 92 ) or the averageprocedure length on a given day (bar graph 5408 depicted further in FIG.94 ). The surgical hub 5706 can be further configured to provide adetailed breakdown of the downtime between procedures according to, forexample, the number and length of the downtime time periods and thesubcategories of the actions or steps during each time period (bar graph5406 depicted further in FIG. 93 ). The surgical hub 5706 can be furtherconfigured to provide a detailed breakdown of the average procedurelength on a given day according to each individual procedure and thesubcategory of actions or steps during each procedure (bar graph 5410depicted further in FIG. 95 ). The various graphs shown in FIGS. 90-95can represent data tracked by the surgical hub 5706 and can further begenerated automatically or displayed by the surgical hub 5706 inresponse to queries submitted by users.

FIG. 91 illustrates an example bar graph 5402 depicting the number ofpatients 5420 operated on relative to the days of the week 5422 fordifferent operating rooms 5424, 5426. The surgical hub 5706 can beconfigured to provide (e.g., via a display) the number of patients 5420operated on or procedures that are completed in connection with eachsurgical hub 5706, which can be tracked through a situational awarenesssystem or accessing the hospital's EMR database, for example. In oneexemplification, the surgical hub 5706 can further be configured tocollate this data from different surgical hubs 5706 within the medicalfacility that are communicably connected together, which allows eachindividual surgical hub to present the aggregated data of the medicalfacility on a hub-by-hub or operating theater-by-theater basis. In oneexemplification, the surgical hub 5706 can be configured to compare oneor more tracked metrics to a threshold value (which may be unique toeach tracked metric). When at least one of the tracked metrics exceedsthe threshold value (i.e., either increases above or drops below thethreshold value, as appropriate for the particular tracked metric), thenthe surgical hub 5706 provides a visual, audible, or tactile alert tonotify a user of such. For example, the surgical hub 5706 can beconfigured to indicate when the number of patients or proceduresdeviates from an expected, average, or threshold value. For example,FIG. 91 depicts the number of patients on Tuesday 5428 and Thursday 5430for a first operating theater 5424 as being highlighted for being belowexpectation. Conversely, no days are highlighted for a second operatingtheater 5426 for this particular week, which means in this context thatthe number of patients for each day falls within expectations.

FIG. 92 illustrates a bar graph 5404 depicting the total downtimebetween procedures 5432 relative to the days of a week 5434 for aparticular operating room. The surgical hub 5706 can be configured totrack the length of downtime between surgical procedures through asituational awareness system, for example. The situational awarenesssystem can detect or infer when each particular downtime instance isoccurring and then track the length of time for each instance ofdowntime. The surgical hub 5706 can thereby determine the total downtime5432 for each day of the week 5434 by summing the downtime instances foreach particular day. In one exemplification, the surgical hub 5706 canbe configured to provide an alert when the total length of downtime on agiven day (or another unit of time) deviates from an expected, average,or threshold value. For example, FIG. 92 depicts the total downtime 5432on Tuesday 5436 and Friday 5438 as being highlighted for deviating froman expected length of time.

FIG. 93 illustrates a bar graph 5406 depicting the total downtime 5432per day of the week 5434 as depicted in FIG. 92 broken down according toeach individual downtime instance. The number of downtime instances andthe length of time for each downtime instance can be represented withineach day's total downtime. For example, on Tuesday in the firstoperating theater (OR1) there were four instances of downtime betweenprocedures and the magnitude of the first downtime instance indicatesthat it was longer than the other three instances. In oneexemplification, the surgical hub 5706 is configured to further indicatethe particular actions or steps taken during a selected downtimeinstance. For example, in FIG. 93 , Thursday's second downtime instance5440 has been selected, which then causes a callout 5442 to be displayedindicating that this particular downtime instance consisted ofperforming the initial set-up of the operating theater, administeringanesthesia, and prepping the patient. As with the downtime instancesthemselves, the relative size or length of the actions or steps withinthe callout 5442 can correspond to the length of time for eachparticular action or step. The detail views for the downtime instancescan be displayed when a user selects the particular instance, forexample.

FIG. 94 illustrates a bar graph 5408 depicting the average procedurelength 5444 relative to the days of a week 5446 for a particularoperating theater. The surgical hub 5706 can be configured to track theaverage procedure length through a situational awareness system, forexample. The situational awareness system can detect or infer when eachparticular step of a surgical procedure is occurring (see FIG. 86 , forexample) and then track the length of time for each of the steps. Thesurgical hub 5706 can thereby determine the total downtime 5432 for eachday of the week 5434 by summing the lengths of the downtime instancesfor the particular day. In one exemplification, the surgical hub 5706can be configured to indicate when the average procedure length deviatesfrom an expected value. For example, FIG. 94 depicts Thursday's averageprocedure length 5448 for the first operating room (OR1) as beinghighlighted for deviating from an expected length of time.

FIG. 95 illustrates a bar graph 5410 depicting the procedure lengths5450 relative to procedure types 5452. The depicted procedure lengths5450 can either represent the average procedure lengths for particulartypes of procedures or the procedure lengths for each individualprocedure performed on a given day in a given operating theater. Theprocedure lengths 5450 for different procedure types 5452 can then becompared. Further, the average lengths for the steps in a procedure type5452 or the length for each particular step in a particular procedurecan be displayed when a procedure is selected. Further, the proceduretypes 5452 can be tagged with various identifiers for parsing andcomparing different data sets. For example, in FIG. 95 the firstprocedure 5454 corresponds to a colorectal procedure (specifically, alow anterior resection) where there was a preoperative identification ofabdominal adhesions. The second procedure 5456 corresponds to a thoracicprocedure (specifically, a segmentectomy). It should be noted again thatthe procedures depicted in FIG. 95 can represent the lengths of time forindividual procedures or the average lengths of time for all of theprocedures for the given procedure types. Each of the procedures canfurther be broken down according to the length of time for each step inthe procedure. For example, FIG. 95 depicts the second procedure 5456 (athoracic segmentectomy) as including an icon or graphical representation5458 of the length of time spent on the dissect vessels, ligate (thevessels), nodal dissection, and closing steps of the surgical procedure.As with the procedure lengths themselves, the relative size or length ofthe steps within the graphical representation 5442 can correspond to thelength of time for each particular step of the surgical procedure. Thedetail views for the steps of the surgical procedures can be displayedwhen a user selects the particular procedure, for example. In oneexemplification, the surgical hub 5706 can be configured to identifywhen a length of time to complete a given step in the procedure deviatesfrom an expected length of time. For example, FIG. 95 depicts the nodaldissection step as being highlighted for deviating from an expectedlength of time.

In one exemplification, an analytics package of the surgical hub 5706can be configured to provide the user with usage data and resultscorrelations related to the surgical procedures (or downtime betweenprocedures). For example, the surgical hub 5706 can be configured todisplay methods or suggestions to improve the efficiency oreffectiveness of a surgical procedure. As another example, the surgicalhub 5706 can be configured to display methods to improve costallocation. FIGS. 96-101 depict examples of various metrics that can betracked by the surgical hub 5706, which can then be utilized to providemedical facility personnel suggestions for inventory utilization ortechnique outcomes. For example, a surgical hub 5706 could provide asurgeon with a suggestion pertaining to a particular technique outcomeprior to or at the beginning of a surgical procedure based on themetrics tracked by the surgical hub 5706.

FIG. 96 illustrates a bar graph 5460 depicting the average completiontime 5462 for particular procedural steps 5464 for different types ofthoracic procedures. The surgical hub 5706 can be configured to trackand store historical data for different types of procedures andcalculate the average time to complete the procedure (or an individualstep thereof). For example, FIG. 96 depicts the average completion time5462 for thoracic segmentectomy 5466, wedge 5468, and lobectomy 5470procedures. For each type of procedure, the surgical hub 5706 can trackthe average time to complete each step thereof. In this particularexample, the dissection, vessel transection, and node dissection stepsare indicated for each type of procedure. In addition to tracking andproviding the average time for the steps of the procedure types, thesurgical hub 5706 can additionally track other metrics or historicaldata, such as the complication rate for each procedure type (i.e., therate of procedures having at least one complication as defined by thesurgical hub 5706 or the surgeon). Additional tracked metrics for eachprocedure type, such as the complication rate, can also be depicted forcomparison between the different procedure types.

FIG. 97 illustrates a bar graph 5472 depicting the procedure time 5474relative to procedure types 5476. The surgical hub 5706 can beconfigured to track and store historical data or metrics for differentprocedure types 5476 or classes, which can encompass multiple subtypesof procedures. For example, FIG. 97 depicts the procedure time 5474 forsurgical procedures classified as a thoracic 5478, bariatric 5480, orcolorectal 5482 procedure. In various exemplifications, the surgical hub5706 can output the procedure time 5474 for the procedureclassifications expressed in terms of either the total length of time orthe average time spent on the given procedure types 5476. The analyticspackage of the surgical hub 5706 can, for example, provide this data tothe surgeons, hospital officials, or medical personnel to track theefficiency of the queried procedures. For example, FIG. 97 depictsbariatric procedures 5480 as taking a lower average time (i.e., beingmore time efficient) than either thoracic procedures 5478 or colorectalprocedures 5482.

FIG. 98 illustrates a bar graph 5484 depicting operating room downtime5486 relative to the time of day 5488. Relatedly, FIG. 99 illustrates abar graph 5494 depicting operating room downtime 5496 relative to theday of the week 5498. Operating room downtime 5486, 5496 can beexpressed in, for example, a length of a unit of time or relativeutilization (i.e., percentage of time that the operating room is inuse). The operating room downtime data can encompass an individualoperating room or an aggregation of multiple operating rooms at amedical facility. As discussed above, a surgical hub 5706 can beconfigured to track whether a surgical procedure is being performed inthe operating theater associated with the surgical hub 5706 (includingthe length of time that a surgical procedure is or is not beingperformed) utilizing a situational awareness system, for example. Asshown in FIGS. 98 and 99 , the surgical hub 5706 can provide an output(e.g., bar graphs 5484, 5494 or other graphical representations of data)depicting the tracked data pertaining to when the operating room isbeing utilized (i.e., when a surgical procedure is being performed)and/or when there is downtime between procedures. Such data can beutilized to identify ineffectiveness or inefficiencies in performingsurgical procedures, cleaning or preparing operating theaters forsurgery, scheduling, and other metrics associated with operating theateruse. For example, FIG. 98 depicts a comparative increase in operatingroom downtime 5486 at a first instance 5490 from 11:00 a.m.-12:00 p.m.and a second instance 5492 from 3:00-4:00 p.m. As another example, FIG.99 depicts a comparative increase in operating room downtime 5496 onMondays 5500 and Fridays 5502. In various exemplifications, the surgicalhub 5706 can provide operating theater downtime data for a particularinstance (i.e., a specific time, day, week, etc.) or an averageoperating theater downtime data for a category of instances (i.e.,aggregated data for a day, time, week, etc.). Hospital officials orother medical personnel thus could use this data to identify specificinstances where an inefficiency may have occurred or identify trends inparticular days and/or times of day where there may be inefficiencies.From such data, the hospital officials or other medical personnel couldthen investigate to identify the specific reasons for these increaseddowntimes and take corrective action to address the identified reason.

In various exemplifications, the surgical hub 5706 can be configured todisplay data in response to queries in a variety of different formats(e.g., bar graphs, pie graphs, infographics). FIG. 100 illustrates apair of pie charts depicting the percentage of time that the operatingtheater is utilized. The operating theater utilization percentage canencompass an individual operating theater or an aggregation of multipleoperating theaters (e.g., the operating rooms at a medical facility orevery operating room for all medical facilities having surgical hubs5706 connected to the cloud 5702). As discussed above, a surgical hub5706 can be configured to determine when a surgical procedure is or isnot being performed (i.e., whether the operating theater associated withthe surgical hub 5706 is being utilized) using a situational awarenesssystem, for example. In addition to expressing operating theaterutilization in terms of an average or absolute amount for different timeperiods (as depicted in FIGS. 98-99 ), the surgical hub 5706 canadditionally express operating theater utilization in terms of apercentage or relative amount compared to a maximum possibleutilization. As above, the operating theater utilization can be parsedfor particular time periods, including the overall utilization (i.e.,the total historical percentage of time in use) for the particularoperating theater (or groups of operating theaters) or the utilizationover the span of a particular time period. As shown in FIG. 100 , afirst pie chart 5504 depicts the overall operating theater utilization5508 (85%) and a second pie chart 5506 depicts the operating theaterutilization for the prior week 5510 (75%). Hospital officials and othermedical personnel could use this data to identify that there may havebeen some inefficiency that occurred in the prior week that caused theparticular operating theater (or group of operating theaters) to beutilized less efficiently compared to the historical average so thatfurther investigations can be carried out to identify the specificreasons for this decreased utilization.

In some exemplifications, the surgical hub 5706 is configured to trackdetect and track the number of surgical items that are utilized duringthe course of a surgical procedure. This data can then be aggregated anddisplayed (either automatically or in response to a query) according to,for example, a particular time period (e.g., per day or per week) or fora particular surgical procedure type (e.g., thoracic procedures orabdominal procedures). FIG. 101 illustrates a bar graph 5512 depictingconsumed and unused surgical items 5514 relative to procedure type 5516.The surgical hub 5706 can be configured to determine or infer whatsurgical items are being consumed during the course of each surgicalprocedure via a situational awareness system. The situational awarenesssystem can determine or receive the list of surgical items to be used ina procedure (e.g., see FIG. 85B), determine or infer when each procedure(and steps thereof) begins and ends, and determine when a particularsurgical item is being utilized according to the procedural step beingperformed. The inventory of surgical items that are consumed or unusedduring the course of a surgical procedure can be represented in terms ofthe total number of surgical items or the average number of surgicalitems per procedure type 5516, for example. The consumed surgical itemscan include non-reusable items that are utilized during the course of asurgical procedure. The unused surgical items can include additionalitems that are not utilized during the procedure(s) or scrap items. Theprocedure type can correspond to broad classifications of procedures ora specific procedure type or technique for performing a procedure type.For example, in FIG. 101 the procedure types 5516 being compared arethoracic, colorectal, and bariatric procedures. For each of theseprocedure types 5516, the average number of consumed and unused surgicalitems 5514 are both provided. In one aspect, the surgical hub 5706 canbe configured to further parse the consumed and/or unused surgical items5514 by the specific item type. In one exemplification, the surgical hub5706 can provide a detailed breakdown of the surgical items 5514 makingup each item category for each surgical procedure type 5516 andgraphically represent the different categories of surgical items 5514.For example, in FIG. 101 , the unused surgical items are depicted indashed lines and the consumed surgical items are depicted in solidlines. In one exemplification, the surgical hub 5706 is configured tofurther indicate the specific within a category for a particularprocedure type 5516. For example, in FIG. 93 , the consumed itemscategory for the thoracic procedure type has been selected, which thencauses a callout 5520 to be displayed listing the particular surgicalitems in the category: stapler cartridges, sponges, saline, fibrinsealants, surgical sutures, and stapler buttress material. Furthermore,the callout 5520 can be configured to provide the quantities of thelisted items in the category, which may be the average or absolutequantities of the items (either consumed or unused) for the particularprocedure type.

In one exemplification, the surgical hub 5706 can be configured toaggregate tracked data in a redacted format (i.e., with anypatient-identifying information stripped out). Such bulk data can beutilized for academic or business analysis purposes. Further, thesurgical hub 5706 can be configured to upload the redacted or anonymizeddata to a local database of the medical facility in which the surgicalhub 5706 is located, an external database system, or the cloud 5702,whereupon the anonymized data can be accessed by user/clientapplications on demand. The anonymized data can be utilized to compareoutcomes and efficiencies within a hospital or between geographicregions, for example.

The process 5300 depicted in FIG. 89 improves scheduling efficiency byallowing the surgical hubs 5706 to automatically store and providegranular detail on correlations between lengths of time required forvarious procedures according to particular days, particular types ofprocedures, particular hospital staff members, and other such metrics.This process 5300 also reduces surgical item waste by allowing thesurgical hubs 5706 to provide alerts when the amount of surgical itemsbeing consumed, either on a per-procedure basis or as a category, aredeviating from the expected amounts. Such alerts can be provided eitherautomatically or in response to receiving a query.

FIG. 102 illustrates a logic flow diagram of a process 5350 for storingdata from the modular devices and patient information database forcomparison. In the following description, description of the process5350, reference should also be made to FIG. 88 . In one exemplification,the process 5350 can be executed by a control circuit of a surgical hub206, as depicted in FIG. 10 (processor 244). In yet anotherexemplification, the process 5350 can be executed by a distributedcomputing system including a control circuit of a surgical hub 206 incombination with a control circuit of a modular device, such as themicrocontroller 461 of the surgical instrument depicted FIG. 12 , themicrocontroller 620 of the surgical instrument depicted in FIG. 16 , thecontrol circuit 710 of the robotic surgical instrument 700 depicted inFIG. 17 , the control circuit 760 of the surgical instruments 750, 790depicted in FIGS. 18 and 19 , or the controller 838 of the generator 800depicted in FIG. 20 . For economy, the following description of theprocess 5350 will be described as being executed by the control circuitof a surgical hub 5706; however, it should be understood that thedescription of the process 5350 encompasses all of the aforementionedexemplifications.

The control circuit executing the process 5350 receives data from thedata sources, such as the modular device(s) and the patient informationdatabase(s) (e.g., EMR databases) that are communicably coupled to thesurgical hub 5706. The data from the modular devices can include, forexample, usage data (e.g., data pertaining to how often the modulardevice has been utilized, what procedures the modular device has beenutilized in connection with, and who utilized the modular devices) andperformance data (e.g., data pertaining to the internal state of themodular device and the tissue being operated on). The data from thepatient information databases can include, for example, patient data(e.g., data pertaining to the patient's age, sex, and medical history)and patient outcome data (e.g., data pertaining to the outcomes from thesurgical procedure). In some exemplifications, the control circuit cancontinuously receive 5352 data from the data sources before, during, orafter a surgical procedure.

As the data is received 5352, the control circuit aggregates 5354 thedata in comparison groups of types of data. In other words, the controlcircuit causes a first type of data to be stored in association with asecond type of data. However, more than two different types of data canbe aggregated 5354 together into a comparison group. For example, thecontrol circuit could store a particular type of performance data for aparticular type of modular device (e.g., the force to fire for asurgical cutting and stapling instrument or the characterization of theenergy expended by an RF or ultrasonic surgical instrument) inassociation with patient data, such as sex, age (or age range), acondition (e.g., emphysema) associated with the patient. In oneexemplification, when the data is aggregated 5354 into comparisongroups, the data is anonymized such that all patient-identifyinginformation is removed from the data. This allows the data aggregated5354 into comparison groups to be utilized for studies, withoutcompromising confidential patient information. The various types of datacan be aggregated 5354 and stored in association with each other inlookup tables, arrays, and other such formats. In one exemplification,the received 5352 data is automatically aggregated 5354 into comparisongroups. Automatically aggregating 5354 and storing the data allows thesurgical hub 5706 to quickly return results for queries and the groupsof data to be exported for analysis according to specifically desireddata types.

When the control circuit receives 5356 a query for a comparison betweentwo or more of the tracked data types, the process 5350 proceeds alongthe YES branch. The control circuit then retrieves the particularcombination of the data types stored in association with each other andthen displays 5358 a comparison (e.g., a graph or other graphicalrepresentation of the data) between the subject data types. If thecontrol circuit does not receive 5356 a query, the process 5350continues along the NO branch and the control circuit continuesreceiving 5352 data from the data sources.

In one exemplification, the control circuit can be configured toautomatically quantify a correlation between the received 5352 datatypes. In such aspects, the control circuit can calculate a correlationcoefficient (e.g., the Pearson's coefficient) between pairs of datatypes. In one aspect, the control circuit can be configured toautomatically display a report providing suggestions or other feedbackif the quantified correlation exceeds a particular threshold value. Inone aspect, the control circuit of the surgical hub 5706 can beconfigured to display a report on quantified correlations exceeding aparticular threshold value upon receiving a query or request from auser.

In one exemplification, a surgical hub 5706 can compile information onprocedures that the surgical hub 5706 was utilized in the performanceof, communicate with other surgical hubs 5706 within its network (e.g.,a local network of a medical facility or a number of surgical hubs 5706connected by the cloud 5702), and compare results between type ofsurgical procedures or particular operating theaters, doctors, ordepartments. Each surgical hub 5706 can calculate and analyzeutilization, efficiency, and comparative results (relative to allsurgical hubs 5706 across a hospital network, a region, etc.). Forexample, the surgical hub 5706 can display efficiency and comparativedata, including operating theater downtime, operating theater clean-upand recycle time, step-by-step completion timing for procedures(including highlighting which procedural steps take the longest, forexample), average times for surgeons to complete procedures (includingparsing the completion times on a procedure-by-procedure basis),historical completion times (e.g., for completing classes of procedures,specific procedures, or specific steps within a procedure), and/oroperating theater utilization efficiency (i.e., the time efficiency froma procedure to a subsequent procedure). The data that is accessed andshared across networks by the surgical hubs 5706 can include theanonymized data aggregated into comparison groups, as discussed above.

For example, the surgical hub 5706 can be utilized to perform studies ofperformance by instrument type or cartridge type for various procedures.As another example, the surgical hub 5706 can be utilized to performstudies on the performance of individual surgeons. As yet anotherexample, the surgical hub 5706 can be utilized to perform studies on theeffectiveness of different surgical procedures according to patients'characteristics or disease states.

In another exemplification, a surgical hub 5706 can provide suggestionson streamlining processes based on tracked data. For example, thesurgical hub 5706 can suggest different product mixes according to thelength of certain procedures or steps within a procedure (e.g., suggesta particular item that is more appropriate for long procedure steps),suggest more cost effective product mixes based on the utilization ofitems, and/or suggest kitting or pre-grouping certain items to lowerset-up time. In another exemplification, a surgical hub 5706 can compareoperating theater utilization across different surgical groups in orderto better balance high volume surgical groups with surgical groups thathave more flexible bandwidth. In yet another aspect, the surgical hub5706 could be put in a forecasting mode that would allow the surgicalhub 5706 to monitor upcoming procedure preparation and scheduling, thennotify the administration or department of upcoming bottlenecks or allowthem to plan for scalable staffing. The forecasting mode can be basedon, for example, the anticipated future steps of the current surgicalprocedure that is being performed using the surgical hub 5706, which canbe determined by a situational awareness system.

In another exemplification, a surgical hub 5706 can be utilized as atraining tool to allow users to compare their procedure timing to othertypes of individuals or specific individuals within their department(e.g., a resident could compare his or her timing to a particularspecialist or the average time for a specialist within the hospital) orthe department average times. For example, users could identify whatsteps of a surgical procedure they are spending an inordinate amount oftime on and, thus, what steps of the surgical procedure that they needto improve upon.

In one exemplification, all processing of stored data is performedlocally on each surgical hub 5706. In another exemplification, eachsurgical hub 5706 is part of a distributed computing network, whereineach individual surgical hub 5706 compiles and analyzes its stored dataand then communicates the data to the requesting surgical hub 5706. Adistributed computing network could permit fast parallel processing. Inanother exemplification, each surgical hub 5706 is communicablyconnected to a cloud 5702, which can be configured to receive the datafrom each surgical hub 5706 and then perform the necessary processing(data aggregation, calculations, and so on) on the data.

The process 5350 depicted in FIG. 102 improves the ability to determinewhen procedures are being performed inefficiently by allowing thesurgical hubs 5706 to provide alerts when particular procedures, eitheron a per-procedure basis or as category, are deviating from the expectedtimes to complete the procedures. Such alerts can be provided eitherautomatically or in response to receiving a query. This process 5350also improves the ability to perform studies on what surgicalinstruments and surgical procedure techniques provide the best patientoutcomes by automatically tracking and indexing such data ineasily-retrievable and reportable formats.

Some systems described herein offload the data processing that controlsthe modular devices (e.g., surgical instruments) from the modulardevices themselves to an external computing system (e.g., a surgicalhub) and/or a cloud. However in some exemplifications, some modulardevices can sample data (e.g., from the sensors of the surgicalinstruments) at a faster rate that the rate at which the data can betransmitted to and processed by a surgical hub. As one solution, thesurgical hub and the surgical instruments (or other modular devices) canutilize a distributed computing system where at least a portion of thedata processing is performed locally on the surgical instrument. Thiscan avoid data or communication bottlenecks between the instrument andthe surgical hub by allowing the onboard processor of the surgicalinstrument to handle at least some of the data processing when the datasampling rate is exceeding the rate at which the data can be transmittedto the surgical hub. In some exemplifications, the distributed computingsystem can cease distributing the processing between the surgical huband the surgical instrument and instead have the processing be executedsolely onboard the surgical instrument. The processing can be executedsolely by the surgical instrument in situations where, for example, thesurgical hub needs to allocate its processing capabilities to othertasks or the surgical instrument is sampling data at a very high rateand it has the capabilities to execute all of the data processingitself.

Similarly, the data processing for controlling the modular devices, suchas surgical instruments, can be taxing for an individual surgical hub toperform. If the surgical hub's processing of the control algorithms forthe modular devices cannot keep pace with the use of the modulardevices, then the modular devices will not perform adequately becausetheir control algorithms will either not be updated as needed or theupdates to the control algorithms will lag behind the actual use of theinstrument. As one solution, the surgical hubs can be configured toutilize a distributed computing system where at least a portion of theprocessing is performed across multiple separate surgical hubs. This canavoid data or communication bottlenecks between the modular devices andthe surgical hub by allowing each surgical hub to utilize the networkedprocessing power of multiple surgical hubs, which can increase the rateat which the data is processed and thus the rate at which the controlalgorithm adjustments can be transmitted by the surgical hub to thepaired modular devices. In addition to distributing the computingassociated with controlling the various modular devices connected to thesurgical hubs, a distributed computing system can also dynamically shiftcomputing resources between multiple surgical hubs in order to analyzetracked data in response to queries from users and perform other suchfunctions. The distributed computing system for the surgical hubs canfurther be configured to dynamically shift data processing resourcesbetween the surgical hubs when any particular surgical hub becomesovertaxed.

The modular devices that are communicably connectable to the surgicalhub can include sensors, memories, and processors that are coupled tothe memories and configured to receive and analyze data sensed by thesensors. The surgical hub can further include a processor coupled to amemory that is configured to receive (through the connection between themodular device and the surgical hub) and analyze the data sensed by thesensors of the modular device. In one exemplification, the data sensedby the modular device is processed externally to the modular device(e.g., external to a handle assembly of a surgical instrument) by acomputer that is communicably coupled to the modular device. Forexample, the advanced energy algorithms for controlling the operation ofa surgical instrument can be processed by an external computing system,rather than on a controller embedded in the surgical instrument (such asinstrument using an Advanced RISC Machine (ARM) processor). The externalcomputer system processing the data sensed by the modular devices caninclude the surgical hub to which the modular devices are paired and/ora cloud computing system. In one exemplification, data sampled at aparticular rate (e.g., 20 Ms/sec) and a particular resolution (e.g., 12bits resolution) by a surgical instrument is decimated and thentransmitted over a link to the surgical hub to which the surgicalinstrument is paired. Based on this received data, the control circuitof the surgical hub then determines the appropriate control adjustmentsfor the surgical instrument, such as controlling power for an ultrasonicsurgical instrument or RF electrosurgical instrument, setting motortermination points for a motor-driven surgical instrument, and so on.The control adjustments are then transmitted to the surgical instrumentfor application thereon.

Distributed Processing

FIG. 103 illustrates a diagram of a distributed computing system 5600.The distributed computing system 5600 includes a set of nodes 5602 a,5602 b, 5602 c that are communicably coupled by a distributedmulti-party communication protocol such that they execute a shared ordistributed computer program by passing messages therebetween. Althoughthree nodes 5602 a, 5602 b, 5602 c are depicted, the distributedcomputing system 5600 can include any number of nodes 5602 a, 5602 b,5602 c that are communicably connected together. Each of the nodes 5602a, 5602 b, 5602 c comprises a respective memory 5606 a, 5606 b, 5606 cand processor 5604 a, 5604 b, 5604 c coupled thereto. The processors5604 a, 5604 b, 5604 c execute the distributed multi-party communicationprotocol, which is stored at least partially in the memories 5606 a,5606 b, 5606 c. Each node 5602 a, 5602 b, 5602 c can represent either amodular device or a surgical hub. Therefore, the depicted diagramrepresents aspects wherein various combinations of surgical hubs and/ormodular devices are communicably coupled. In various exemplifications,the distributed computing system 5600 can be configured to distributethe computing associated with controlling the modular device(s) (e.g.,advanced energy algorithms) over the modular device(s) and/or thesurgical hub(s) to which the modular device(s) are connected. In otherwords, the distributed computing system 5600 embodies a distributedcontrol system for controlling the modular device(s) and/or surgicalhub(s).

In some exemplifications, the modular device(s) and surgical hub(s)utilize data compression for their communication protocols. Wirelessdata transmission over sensor networks can consume a significant amountof energy and/or processing resources compared to data computation onthe device itself. Thus data compression can be utilized to reduce thedata size at the cost of extra processing time on the device. In oneexemplification, the distributed computing system 5600 utilizes temporalcorrelation for sensing data, data transformation from one dimension totwo dimension, and data separation (e.g., upper 8 bit and lower 8 bitdata). In another exemplification, the distributed computing system 5600utilizes a collection tree protocol for data collection from differentnodes 5602 a, 5602 b, 5602 c having sensors (e.g., modular devices) to aroot node. In yet another aspect, the distributed computing system 5600utilizes first-order prediction coding to compress the data collected bythe nodes 5602 a, 5602 b, 5602 c having sensors (e.g., modular devices),which can minimize the amount of redundant information and greatlyreduce the amount of data transmission between the nodes 5602 a, 5602 b,5602 c of the network. In yet another exemplification, the distributedcomputing system 5600 is configured to transmit only theelectroencephalogram (EEG) features. In still yet anotherexemplification, the distributed computing system 5600 can be configuredto transmit only the complex data features that are pertinent to thesurgical instrument detection, which can save significant power inwireless transmission. Various other exemplifications can utilizecombinations of the aforementioned data compression techniques and/oradditional techniques of data compression.

FIG. 104 illustrates a logic flow diagram of a process 5650 for shiftingdistributed computing resources. In the following description of the5650, reference should also be made to FIG. 103 . In oneexemplification, the process 5650 can be executed by a distributedcomputing system including a control circuit of a surgical hub 206, asdepicted in FIG. 10 (processor 244), in combination with a controlcircuit of a second surgical hub 206 and/or a control circuit of amodular device, such as the microcontroller 461 of the surgicalinstrument depicted FIG. 12 , the microcontroller 620 of the surgicalinstrument depicted in FIG. 16 , the control circuit 710 of the roboticsurgical instrument 700 depicted in FIG. 17 , the control circuit 760 ofthe surgical instruments 750, 790 depicted in FIGS. 18 and 19 , or thecontroller 838 of the generator 800 depicted in FIG. 20 . For economy,the following description of the process 5650 will be described as beingexecuted by the control circuits of one or more nodes; however, itshould be understood that the description of the process 5650encompasses all of the aforementioned exemplifications.

The control circuits of each node execute 5652 a distributed controlprogram in synchrony. As the distributed control program is beingexecuted across the network of nodes, at least one of the controlcircuits monitors for a command instructing the distributed computingsystem to shift from a first mode, wherein the distributed computingprogram is executed across the network of nodes, to a second mode,wherein the control program is executed by a single node. In oneexemplification, the command can be transmitted by a surgical hub inresponse to the surgical hub's resources being needed for an alternativecomputing task. In another exemplification, the command can betransmitted by a modular device in response to the rate at which thedata is sampled by the modular device outpacing the rate at which thesampled data can be communicated to the other nodes in the network. If acontrol circuit determines that an appropriate command has been received5654, the process 5650 continues along the YES branch and thedistributed computing system 5600 shifts to a single node executing 5656the program. For example, the distributed computing system 5600 shiftsthe distributed computing program from being executed by both a modulardevice and a surgical hub to being executed solely by the modulardevice. As another example, the distributed computing system 5600 shiftsthe distributed computing program from being executed by both a firstsurgical hub and a second surgical hub to being executed solely by thefirst surgical hub. If no control circuit determines that an appropriatecommand has been received 5654, the process continues along the NObranch and the control circuits of the network of nodes continuesexecuting 5652 the distributed computing program across the network ofnodes.

In the event that the program has been shifted to being executed 5656 bya single node, the control circuit of the particular node solelyexecuting the distributed program and/or a control circuit of anothernode within the network (which previously was executing the distributedprogram) monitors for a command instructing the node to re-distributethe processing of the program across the distributed computing system.In other words, the node monitors for a command to re-initiate thedistributed computing system. In one exemplification, the command tore-distribute the processing across the network can be generated whenthe sampling rate of the sensor is less than the data communication ratebetween the modular device and the surgical hub. If a control circuitreceives 5658 an appropriate command to re-distribute the processing,then the process 5650 proceeds along the YES branch and the program isonce again executed 5652 across the node network. If a control circuithas not received 5658 an appropriate command, then the node continuessingularly executing 5656 the program.

The process 5650 depicted in FIG. 104 eliminates data or communicationbottlenecks in controlling modular devices by utilizing a distributedcomputing architecture that can shift computing resources either betweenthe modular devices and surgical hubs or between the surgical hubs asneeded. This process 5650 also improves the modular devices' dataprocessing speed by allowing the processing of the modular devices'control adjustments to be executed at least in part by the modulardevices themselves. This process 5650 also improves the surgical hubs'data processing speed by allowing the surgical hubs to shift computingresources between themselves as necessary.

It can be difficult during video-assisted surgical procedures, such aslaparoscopic procedures, to accurately measure sizes or dimensions offeatures being viewed through a medical imaging device due to distortiveeffects caused by the device's lens. Being able to accurately measuresizes and dimensions during video-assisted procedures could assist asituational awareness system for a surgical hub by allowing the surgicalhub to accurately identify organs and other structures duringvideo-assisted surgical procedures. As one solution, a surgical hubcould be configured to automatically calculate sizes or dimensions ofstructures (or distances between structures) during a surgical procedureby comparing the structures to markings affixed to devices that areintended to be placed within the FOV of the medical imaging deviceduring a surgical procedure. The markings can represent a known scale,which can then be utilized to make measurements by comparing the unknownmeasured length to the known scale.

In one exemplification, the surgical hub is configured to receive imageor video data from a medical imaging device paired with the surgicalhub. When a surgical instrument bearing a calibration scale is withinthe FOV of the medical imaging device, the surgical hub is able tomeasure organs and other structures that are likewise within the medicalimaging device's FOV by comparing the structures to the calibrationscale. The calibration scale can be positioned on, for example, thedistal end of a surgical instrument.

FIG. 105 illustrates a diagram of an imaging system 5800 and a surgicalinstrument 5806 bearing a calibration scale 5808. The imaging system5800 includes a medical imaging device 5804 that is paired with asurgical hub 5802. The surgical hub 5802 can include a patternrecognition system or a machine learning system configured to recognizefeatures in the FOV from image or video data received from the medicalimaging device 5804. In one exemplification, a surgical instrument 5806(e.g., a surgical cutting and stapling instrument) that is intended toenter the FOV of the medical imaging device 5804 during a surgicalprocedure includes a calibration scale 5808 affixed thereon. Thecalibration scale 5808 can be positioned on the exterior surface of thesurgical instrument 5806, for example. In aspects wherein the surgicalinstrument 5806 is a surgical cutting and stapling instrument, thecalibration scale 5808 can be positioned along the exterior surface ofthe anvil. The calibration scale 5808 can include a series of graphicalmarkings separated at fixed and/or known intervals. The distance betweenthe end or terminal markings of the calibration scale 5808 can likewisebe a set distance L (e.g., 35 mm). In one exemplification, the endmarkings (e.g., the most proximal marking and the most distal marking)of the calibration scale 5808 are differentiated from the intermediatemarkings in size, shape, color, or another such fashion. This allows theimage recognition system of the surgical hub 5802 to identify the endmarkings separately from the intermediate markings. The distance(s)between the markings can be stored in a memory or otherwise retrieved bythe surgical hub 5802. The surgical hub 5802 can thus measure lengths orsizes of structures relative to the provided calibration scale 5808. InFIG. 105 , for example, the surgical hub 5802 can calculate that theartery 5810 a has a diameter or width of D1 (e.g., 17.0 mm), the vein5810 b has a diameter or width of D2 (e.g., 17.5 mm), and the distancebetween the vessels is D3 (e.g., 20 mm) by comparing the visualizationsof these distances D1, D2, D3 to the known length L of the calibrationscale 5808 positioned on the surgical instrument 5806 within the FOV ofthe medical imaging device 5804. The surgical hub 5802 can recognize thepresence of the vessels 5810 a, 5810 b via an image recognition system.In some exemplifications, the surgical hub 5802 can be configured toautomatically measure and display the size or dimension of detectedfeatures within the FOV of the medical imaging device 5804. In someexemplifications, the surgical hub 5802 can be configured to calculatethe distance between various points selected by a user on an interactivedisplay that is paired with the surgical hub 5802.

The imaging system 5800 configured to detect and measure sizes accordingto a calibration scale 5808 affixed to surgical instruments 5806provides the ability to accurately measure sizes and distances duringvideo-assisted procedures. This can make it easier for surgeons toprecisely perform video-assisted procedures by compensating for theoptically distortive effects inherent in such procedures.

User Feedback Methods

The present disclosure provides user feedback techniques. In one aspect,the present disclosure provides a display of images through a medicalimaging device (e.g., laparoscope, endoscope, thoracoscope, and thelike). A medical imaging device comprises an optical component and animage sensor. The optical component may comprise a lens and a lightsource, for example. The image sensor may be implemented as a chargecoupled device (CCD) or complementary oxide semiconductor (CMOS). Theimage sensor provides image data to electronic components in thesurgical hub. The data representing the images may be transmitted bywired or wireless communication to display instrument status, feedbackdata, imaging data, and highlight tissue irregularities and underliningstructures. In another aspect, the present disclosure provides wired orwireless communication techniques for communicating user feedback from adevice (e.g., instrument, robot, or tool) to the surgical hub. Inanother aspect, the present disclosure provides identification and usagerecording and enabling. Finally, in another aspect, the surgical hub mayhave a direct interface control between the device and the surgical hub.

Through Laparoscope Monitor Display of Data

In various aspects, the present disclosure provides through laparoscopemonitor display of data. The through laparoscope monitor display of datamay comprise displaying a current instrument alignment to adjacentprevious operations, cooperation between local instrument displays andpaired laparoscope display, and display of instrument specific dataneeded for efficient use of an end-effector portion of a surgicalinstrument. Each of these techniques is described hereinbelow.

Display of Current Instrument Alignment to Adjacent Previous Operations

In one aspect, the present disclosure provides alignment guidancedisplay elements that provide the user information about the location ofa previous firing or actuation and allow them to align the nextinstrument use to the proper position without the need for seeing theinstrument directly. In another aspect, the first device and seconddevice and are separate; the first device is within the sterile fieldand the second is used from outside the sterile field.

During a colorectal transection using a double-stapling technique it isdifficult to align the location of an anvil trocar of a circular staplerwith the center of an overlapping staple line. During the procedure, theanvil trocar of the circular stapler is inserted in the rectum below thestaple line and a laparoscope is inserted in the peritoneal cavity abovethe staple line. Because the staple line seals off the colon, there isno light of sight to align the anvil trocar using the laparoscope tooptically align the anvil trocar insertion location relative to thecenter of the staple line overlap.

One solution provides a non-contact sensor located on the anvil trocarof the circular stapler and a target located at the distal end of thelaparoscope. Another solution provides a non-contact sensor located atthe distal end of the laparoscope and a target located on the anviltrocar of the circular stapler.

A surgical hub computer processor receives signals from the non-contactsensor and displays a centering tool on a screen indicating thealignment of the anvil trocar of the circular stapler and the overlapportion at the center of staple line. The screen displays a first imageof the target staple line with a radius around the staple line overlapportion and a second image of the projected anvil trocar location. Theanvil trocar and the overlap portion at the center of staple line arealigned when the first and second images overlap.

In one aspect, the present disclosure provides a surgical hub foraligning a surgical instrument. The surgical hub comprises a processorand a memory coupled to the processor. The memory stores instructionsexecutable by the processor to receive image data from an image sensor,generate a first image based on the image data, display the first imageon a monitor coupled to the processor, receive a signal from anon-contact sensor, generate a second image based on the position of thesurgical device, and display the second image on the monitor. The firstimage data represents a center of a staple line seal. The first imagerepresents a target corresponding to the center of the staple line. Thesignal is indicative of a position of a surgical device relative to thecenter of the staple line. The second image represents the position ofthe surgical device along a projected path of the surgical device towardthe center of the staple line.

In one aspect, the center of the staple line is a double-staple overlapportion zone. In another aspect, the image sensor receives an image froma laparoscope. In another aspect, the surgical device is a circularstapler comprising an anvil trocar and the non-contact sensor isconfigured to detect the location of the anvil trocar relative to thecenter of the staple line seal. In another aspect, the non-contactsensor is an inductive sensor. In another aspect, the non-contact sensoris a capacitive sensor.

In various aspects, the present disclosure provides a control circuit toalign the surgical instrument as described above. In various aspects,the present disclosure provides a non-transitory computer readablemedium storing computer readable instructions which, when executed,causes a machine to align the surgical instrument as described above.

This technique provides better alignment of a surgical instrument suchas a circular stapler about the overlap portion of the staple line toproduce a better seal and cut after the circular stapler is fired.

In one aspect, the present disclosure provides a system for displayingthe current instrument alignment relative to prior adjacent operations.The instrument alignment information may be displayed on a monitor orany suitable electronic device suitable for the visual presentation ofdata whether located locally on the instrument or remotely from theinstrument through the modular communication hub. The system may displaythe current alignment of a circular staple cartridge to an overlappingstaple line, display the current alignment of a circular staplecartridge relative to a prior linear staple line, and/or show theexisting staple line of the linear transection and an alignment circleindicating an appropriately centered circular staple cartridge. Each ofthese techniques is described hereinbelow.

In one aspect, the present disclosure provides alignment guidancedisplay elements that provide the user information about the location ofa previous firing or actuation of a surgical instrument (e.g., surgicalstapler) and allows the user to align the next instrument use (e.g.,firing or actuation of the surgical stapler) to the proper positionwithout the need for seeing the instrument directly. In another aspect,the present disclosure provides a first device and a second device thatis separate from the first device. The first device is located within asterile field and the second is located outside the sterile field. Thetechniques described herein may be applied to surgical staplers,ultrasonic instruments, electrosurgical instruments, combinationultrasonic/electrosurgical instruments, and/or combination surgicalstapler/electrosurgical instruments.

FIG. 106 illustrates a diagram 6000 of a surgical instrument 6002centered on a staple line 6003 using the benefit of centering tools andtechniques described in connection with FIGS. 23-33 , according to oneaspect of the present disclosure. As used in the following descriptionof FIGS. 107-117 a staple line may include multiple rows of staggeredstaples and typically includes two or three rows of staggered staples,without limitation. The staple line may be a double staple line 6004formed using a double-stapling technique as described in connection withFIGS. 107-111 or may be a linear staple line 6052 formed using a lineartransection technique as described in connection with FIGS. 112-117 .The centering tools and techniques described herein can be used to alignthe instrument 6002 located in one part of the anatomy with either thestaple line 6003 or with another instrument located in another part ofthe anatomy without the benefit of a line of sight. The centering toolsand techniques include displaying the current alignment of theinstrument 6002 adjacent to previous operations. The centering tool isuseful, for example, during laparoscopic-assisted rectal surgery thatemploy a double-stapling technique, also referred to as an overlappingstapling technique. In the illustrated example, during alaparoscopic-assisted rectal surgical procedure, a circular stapler 6002is positioned in the rectum 6006 of a patient within the pelvic cavity6008 and a laparoscope is positioned in the peritoneal cavity.

During the laparoscopic-assisted rectal surgery, the colon is transectedand sealed by the staple line 6003 having a length “l.” Thedouble-stapling technique uses the circular stapler 6002 to create anend-to-end anastomosis and is currently used widely inlaparoscopic-assisted rectal surgery. For a successful formation of ananastomosis using a circular stapler 6002, the anvil trocar 6010 of thecircular stapler 6002 should be aligned with the center “l/2” of thestaple line 6003 transection before puncturing through the center “l/2”of the staple line 6003 and/or fully clamping on the tissue beforefiring the circular stapler 6002 to cut out the staple overlap portion6012 and forming the anastomosis. Misalignment of the anvil trocar 6010to the center of the staple line 6003 transection may result in a highrate of anastomotic failures. This technique may be applied toultrasonic instruments, electrosurgical instruments, combinationultrasonic/electrosurgical instruments, and/or combination surgicalstapler/electrosurgical instruments. Several techniques are nowdescribed for aligning the anvil trocar 6010 of the circular stapler6002 to the center “l/2” of the staple line 6003.

In one aspect, as described in FIGS. 107-109 and with reference also toFIGS. 1-11 to show interaction with an interactive surgical system 100environment including a surgical hub 106, 206, the present disclosureprovides an apparatus and method for detecting the overlapping portionof the double staple line 6004 in a laparoscopic-assisted rectal surgerycolorectal transection using a double stapling technique. Theoverlapping portion of the double staple line 6004 is detected and thecurrent location of the anvil trocar 6010 of the circular stapler 6002is displayed on a surgical hub display 215 coupled to the surgical hub206. The surgical hub display 215 displays the alignment of a circularstapler 6002 cartridge relative to the overlapping portion of the doublestaple line 6004, which is located at the center of the double stapleline 6004. The surgical hub display 215 displays a circular imagecentered around the overlapping double staple line 6004 region to ensurethat the overlapping portion of the double staple line 6004 is containedwithin the knife of the circular stapler 6002 and therefore removedfollowing the circular firing. Using the display, the surgeon aligns theanvil trocar 6010 with the center of the double staple line 6004 beforepuncturing through the center of the double staple line 6004 and/orfully clamping on the tissue before firing the circular stapler 6002 tocut out the staple overlap portion 6012 and form the anastomosis.

FIGS. 107-109 illustrate a process of aligning an anvil trocar 6010 of acircular stapler 6022 to a staple overlap portion 6012 of a doublestaple line 6004 created by a double-stapling technique, according toone aspect of the present disclosure. The staple overlap portion 6012 iscentered on the double staple line 6004 formed by a double-staplingtechnique. The circular stapler 6002 is inserted into the colon 6020below the double staple line 6004 and a laparoscope 6014 is insertedthrough the abdomen above the double staple line 6004. A laparoscope6014 and a non-contact sensor 6022 are used to determine an anvil trocar6010 location relative to the staple overlap portion 6012 of the doublestaple line 6004. The laparoscope 6014 includes an image sensor togenerate an image of the double staple line 6004. The image sensor imageis transmitted to the surgical hub 206 via the imaging module 238. Thesensor 6022 generates a signal 6024 that detects the metal staples usinginductive or capacitive metal sensing technology. The signal 6024 variesbased on the position of the anvil trocar 6010 relative to the stapleoverlap portion 6004. A centering tool 6030 presents an image 6038 ofthe double staple line 6004 and a target alignment ring 6032circumscribing the image 6038 of the double staple line 6004 centeredabout an image 6040 of the staple overlap portion 6012 on the surgicalhub display 215. The centering tool 6030 also presents a projected cutpath 6034 of an anvil knife of the circular stapler 6002. The alignmentprocess includes displaying an image 6038 of the double staple line 6004and a target alignment ring 6032 circumscribing the image 6038 of thedouble staple line 6004 centered on the image 6040 of the staple overlapportion 6012 to be cut out by the circular knife of the circular stapler6002. Also displayed is an image of a crosshair 6036 (X) relative to theimage 6040 of the staple overlap portion 6012.

FIG. 107 illustrates an anvil trocar 6010 of a circular stapler 6002that is not aligned with a staple overlap portion 6012 of a doublestaple line 6004 created by a double-stapling technique. The doublestaple line 6004 has a length “l” and the staple overlap portion 6012 islocated midway along the double staple line 6004 at “l/2.” As shown inFIG. 107 , the circular stapler 6002 is inserted into a section of thecolon 6020 and is positioned just below the double staple line 6004transection. A laparoscope 6014 is positioned above the double stapleline 6004 transection and feeds an image of the double staple line 6004and staple overlap portion 6012 within the field of view 6016 of thelaparoscope 6014 to the surgical hub display 215. The position of theanvil trocar 6010 relative to the staple overlap portion 6012 isdetected by a sensor 6022 located on the circular stapler 6002. Thesensor 6022 also provides the position of the anvil trocar 6010 relativeto the staple overlap portion 6012 to the surgical hub display 215.

As shown in In FIG. 107 , the projected path 6018 of the anvil trocar6010 is shown along a broken line to a position marked by an X. As shownin FIG. 107 , the projected path 6018 of the anvil trocar 6010 is notaligned with the staple overlap portion 6012. Puncturing the anviltrocar 6010 through the double staple line 6004 at a point off thestaple overlap portion 6012 could lead to an anastomotic failure. Usingthe anvil trocar 6010 centering tool 6030 described in FIG. 109 , thesurgeon can align the anvil trocar 6010 with the staple overlap portion6012 using the images displayed by the centering tool 6030. For example,in one implementation, the sensor 6022 is an inductive sensor. Since thestaple overlap portion 6012 contains more metal than the rest of thelateral portions of the double staple line 6004, the signal 6024 ismaximum when the sensor 6022 is aligned with and proximate to the stapleoverlap portion 6012. The sensor 6022 provides a signal to the surgicalhub 206 that indicates the location of the anvil trocar 6010 relative tothe staple overlap portion 6012. The output signal is converted to avisualization of the location of the anvil trocar 6010 relative to thestaple overlap portion 6012 that is displayed on the surgical hubdisplay 215.

As shown in FIG. 108 , the anvil trocar 6010 is aligned with the stapleoverlap portion 6012 at the center of the double staple line 6004created by a double-stapling technique. The surgeon can now puncture theanvil trocar 6010 through the staple overlap portion 6012 of the doublestaple line 6004 and/or fully clamp on the tissue before firing thecircular stapler 6002 to cut out the staple overlap portion 6012 andform an anastomosis.

FIG. 109 illustrates a centering tool 6030 displayed on a surgical hubdisplay 215, the centering tool providing a display of a staple overlapportion 6012 of a double staple line 6004 created by a double-stalingtechnique, where the anvil trocar 6010 is not aligned with the stapleoverlap portion 6012 of the double staple line 6004 as shown in FIG. 107. The centering tool 6030 presents an image 6038 on the surgical hubdisplay 215 of the double staple line 6004 and an image 6040 of thestaple overlap portion 6012 received from the laparoscope 6014. A targetalignment ring 6032 centered about the image 6040 of the staple overlapportion 6012 circumscribes the image 6038 of the double staple line 6004to ensure that the staple overlap portion 6012 is located within thecircumference of the projected cut path 6034 of the circular stapler6002 knife when the projected cut path 6034 is aligned to the targetalignment ring 6032. The crosshair 6036 (X) represents the location ofthe anvil trocar 6010 relative to the staple overlap portion 6012. Thecrosshair 6036 (X) indicates the point through the double staple line6004 where the anvil trocar 6010 would puncture if it were advanced fromits current location.

As shown in FIG. 109 , the anvil trocar 6010 is not aligned with thedesired puncture through location designated by the image 6040 of thestaple overlap portion 6012. To align the anvil trocar 6010 with thestaple overlap portion 6012 the surgeon manipulates the circular stapler6002 until the projected cut path 6034 overlaps the target alignmentring 6032 and the crosshair 6036 (X) is centered on the image 6040 ofthe staple overlap portion 6012. Once alignment is complete, the surgeonpunctures the anvil trocar 6010 through the staple overlap portion 6012of the double staple line 6004 and/or fully clamps on the tissue beforefiring the circular stapler 6002 to cut out the staple overlap portion6012 and form the anastomosis.

As discussed above, the sensor 6022 is configured to detect the positionof the anvil trocar 6010 relative to the staple overlap portion 6012.Accordingly, the location of the crosshair 6036 (X) presented on thesurgical hub display 215 is determined by the surgical stapler sensor6022. In another aspect, the sensor 6022 may be located on thelaparoscope 6014, where the sensor 6022 is configured to detect the tipof the anvil trocar 6010. In other aspects, the sensor 6022 may belocated either on the circular stapler 6022 or the laparoscope 6014, orboth, to determine the location of the anvil trocar 6010 relative to thestaple overlap portion 6012 and provide the information to the surgicalhub display 215 via the surgical hub 206.

FIGS. 110 and 111 illustrate a before image 6042 and an after image 6043of a centering tool 6030, according to one aspect of the presentdisclosure. FIG. 110 illustrates an image of a projected cut path 6034of an anvil trocar 6010 and circular knife before alignment with thetarget alignment ring 6032 circumscribing the image 6038 of the doublestaple line 6004 over the image 6040 of the staple overlap portion 6040presented on a surgical hub display 215. FIG. 111 illustrates an imageof a projected cut path 6034 of an anvil trocar 6010 and circular knifeafter alignment with the target alignment ring 6032 circumscribing theimage 6038 of the double staple line 6004 over the image 6040 of thestaple overlap portion 6040 presented on a surgical hub display 215. Thecurrent location of the anvil trocar 6010 is marked by the crosshair6036 (X), which as shown in FIG. 110 , is positioned below and to theleft of center of the image 6040 of the staple overlap portion 6040. Asshown in FIG. 111 , as the surgeon moves the anvil trocar 6010 of thealong the projected path 6046, the projected cut path 6034 aligns withthe target alignment ring 6032. The target alignment ring 6032 may bedisplayed as a greyed out alignment circle overlaid over the currentposition of the anvil trocar 6010 relative to the center of the doublestaple line 6004, for example. The image may include indication marks toassist the alignment process by indication which direction to move theanvil trocar 6010. The target alignment ring 6032 may be shown in bold,change color or may be highlighted when it is located within apredetermined distance of center within acceptable limits.

In another aspect, the sensor 6022 may be configured to detect thebeginning and end of a linear staple line in a colorectal transectionand to provide the position of the current location of the anvil trocar6010 of the circular stapler 6002. In another aspect, the presentdisclosure provides a surgical hub display 215 to present the circularstapler 6002 centered on the linear staple line, which would create evendog ears, and to provide the current position of the anvil trocar 6010to allow the surgeon to center or align the anvil trocar 6010 as desiredbefore puncturing and/or fully clamping on tissue prior to firing thecircular stapler 6002.

In another aspect, as described in FIGS. 112-114 and with reference alsoto FIGS. 1-11 to show interaction with an interactive surgical system100 environment including a surgical hub 106, 206, in alaparoscopic-assisted rectal surgery colorectal transection using alinear stapling technique, the beginning and end of the linear stapleline 6052 is detected and the current location of the anvil trocar 6010of the circular stapler 6002 is displayed on a surgical hub display 215coupled to the surgical hub 206. The surgical hub display 215 displays acircular image centered on the double staple line 6004, which wouldcreate even dog ears and the current position of the anvil trocar 6002is displayed to allow the surgeon to center or align the anvil trocar6010 before puncturing through the linear staple line 6052 and/or fullyclamping on the tissue before firing the circular stapler 6002 to cutout the center 6050 of the linear staple line 6052 to form ananastomosis.

FIGS. 112-114 illustrate a process of aligning an anvil trocar 6010 of acircular stapler 6022 to a center 6050 of a linear staple line 6052created by a linear stapling technique, according to one aspect of thepresent disclosure. FIGS. 112 and 113 illustrate a laparoscope 6014 anda sensor 6022 located on the circular stapler 6022 to determine thelocation of the anvil trocar 6010 relative to the center 6050 of thelinear staple line 6052. The anvil trocar 6010 and the sensor 6022 isinserted into the colon 6020 below the linear staple line 6052 and thelaparoscope 6014 is inserted through the abdomen above the linear stapleline 6052.

FIG. 112 illustrates the anvil trocar 6010 out of alignment with thecenter 6050 of the linear staple line 6052 and FIG. 113 illustrates theanvil trocar 6010 in alignment with the center 6050 of the linear stapleline 6052. The sensor 6022 is used to detect the center 6050 of thelinear staple line 6052 to align the anvil trocar 6010 with the centerof the staple line 6052. In one aspect, the center 6050 of the linearstaple line 6052 may be located by moving the circular stapler 6002until one end of the linear staple line 6052 is detected. An end may bedetected when there are no more staples in the path of the sensor 6022.Once one of the ends is reached, the circular stapler 6002 is movedalong the linear staple line 6053 until the opposite end is detected andthe length “1” of the linear staple line 6052 is determined bymeasurement or by counting individual staples by the sensor 6022. Oncethe length of the linear staple line 6052 is determined, the center 6050of the linear staple line 6052 can be determined by dividing the lengthby two “l/2.”

FIG. 114 illustrates a centering tool 6054 displayed on a surgical hubdisplay 215, the centering tool providing a display of a linear stapleline 6052, where the anvil trocar 6010 is not aligned with the stapleoverlap portion 6012 of the double staple line 6004 as shown in FIG. 112. The surgical hub display 215 presents a standard reticle field of view6056 of the laparoscopic field of view 6016 of the linear staple line6052 and a portion of the colon 6020. The surgical hub display 215 alsopresents a target ring 6062 circumscribing the image center of thelinear staple line and a projected cut path 6064 of the anvil trocar andcircular knife. The crosshair 6066 (X) represents the location of theanvil trocar 6010 relative to the center 6050 of the linear staple line6052. The crosshair 6036 (X) indicates the point through the linearstaple line 6052 where the anvil trocar 6010 would puncture if it wereadvanced from its current location.

As shown in FIG. 114 , the anvil trocar 6010 is not aligned with thedesired puncture through location designated by the offset between thetarget ring 6062 and the projected cut path 6064. To align the anviltrocar 6010 with the center 6050 of the linear staple line 6052 thesurgeon manipulates the circular stapler 6002 until the projected cutpath 6064 overlaps the target alignment ring 6062 and the crosshair 6066(X) is centered on the image 6040 of the staple overlap portion 6012.Once alignment is complete, the surgeon punctures the anvil trocar 6010through the center 6050 of the linear staple line 6052 and/or fullyclamps on the tissue before firing the circular stapler 6002 to cut outthe staple overlap portion 6012 and forming the anastomosis.

In one aspect, the present disclosure provides an apparatus and methodfor displaying an image of an linear staple line 6052 using a lineartransection technique and an alignment ring or bullseye positioned as ifthe anvil trocar 6010 of the circular stapler 6022 were centeredappropriately along the linear staple line 6052. The apparatus displaysa greyed out alignment ring overlaid over the current position of theanvil trocar 6010 relative to the center 6050 of the linear staple line6052. The image may include indication marks to assist the alignmentprocess by indication which direction to move the anvil trocar 6010. Thealignment ring may be bold, change color or highlight when it is locatedwithin a predetermined distance of centered.

With reference now to FIGS. 112-115 , FIG. 115 is an image 6080 of astandard reticle field view 6080 of a linear staple line 6052transection of a surgical as viewed through a laparoscope 6014 displayedon the surgical hub display 215, according to one aspect of the presentdisclosure. In a standard reticle view 6080, it is difficult to see thelinear staple line 6052 in the standard reticle field of view 6056.Further, there are no alignment aids to assist with alignment andintroduction of the anvil trocar 6010 to the center 6050 of the linearstaple line. This view does not show an alignment circle or alignmentmark to indicate if the circular stapler is centered appropriately anddoes not show the projected trocar path. In this view it also difficultto see the staples because there is no contrast with the backgroundimage.

With reference now to FIGS. 112-116 , FIG. 116 is an image 6082 of alaser-assisted reticle field of view 6072 of the surgical site shown inFIG. 115 before the anvil trocar 6010 and circular knife of the circularstapler 6002 are aligned to the center 6050 of the linear staple line6052, according to one aspect of the present disclosure. Thelaser-assisted reticle field of view 6072 provides an alignment mark orcrosshair 6066 (X), currently positioned below and to the left of centerof the linear staple line 6052 showing the projected path of the anviltrocar 6010 to assist positioning of the anvil trocar 6010. In additionto the projected path marked by the crosshair 6066 (X) of the anviltrocar 6010, the image 6082 displays the staples of the linear stapleline 6052 in a contrast color to make them more visible against thebackground. The linear staple line 6052 is highlighted and a bullseyetarget 6070 is displayed over the center 6050 of the linear staple line6052. Outside of the laser-assisted reticle field of view 6072, theimage 6082 displays a status warning box 6068, a suggestion box 6074, atarget ring 6062, and the current alignment position of the anvil trocar6010 marked by the crosshair 6066 (X) relative to the center 6050 of thelinear staple line 6052. As shown in FIG. 116 , the status warning box6068 indicates that the trocar is “MISALIGNED” and the suggestion box6074 states “Adjust trocar to center staple line.”

With reference now to FIGS. 112-117 , FIG. 117 is an image 6084 of alaser-assisted reticle field of view 6072 of the surgical site shown inFIG. 116 after the anvil trocar 6010 and circular knife of the circularstapler 6002 are aligned to the center 6050 of the linear staple line6052, according to one aspect of the present disclosure. Thelaser-assisted reticle field of view 6072 provides an alignment mark orcrosshair 6066 (X), currently positioned below and to the left of centerof the linear staple line 6052 showing the projected path of the anviltrocar 6010 to assist positioning of the anvil trocar 6010. In additionto the projected path marked by the crosshair 6066 (X) of the anviltrocar 6010, the image 6082 displays the staples of the linear stapleline 6052 in a contrast color to make them more visible against thebackground. The linear staple line 6052 is highlighted and a bullseyetarget 6070 is displayed over the center 6050 of the linear staple line6052. Outside of the laser-assisted reticle field of view 6072, theimage 6082 displays a status warning box 6068, a suggestion box 6074, atarget ring 6062, and the current alignment position of the anvil trocar6010 marked by the crosshair 6066 (X) relative to the center 6050 of thelinear staple line 6052. As shown in FIG. 116 , the status warning box6068 indicates that the trocar is “MISALIGNED” and the suggestion box6074 states “Adjust trocar to center staple line.”

FIG. 117 is a laser assisted view of the surgical site shown in FIG. 116after the anvil trocar 6010 and circular knife are aligned to the centerof the staple line 6052. In this view, inside the field of view 6072 ofthe laser-assisted reticle, the alignment mark crosshair 6066 (X) ispositioned over the center of the staple line 6052 and the highlightedbullseye target to indicate alignment of the trocar to the center of thestaple line. Outside the field of view 6072 of the laser-assistedreticle, the status warning box indicates that the trocar is “ALIGNED”and the suggestion is “Proceed trocar introduction.”

FIG. 118 illustrates a non-contact inductive sensor 6090 implementationof the non-contact sensor 6022 to determine an anvil trocar 6010location relative to the center of a staple line transection (the stapleoverlap portion 6012 of the double staple line 6004 shown in FIGS.107-108 or the center 6050 of the linear staple line 6052 shown in FIGS.112-113 , for example), according to one aspect of the presentdisclosure. The non-contact inductive sensor 6090 includes an oscillator6092 that drives an inductive coil 6094 to generate an electromagneticfield 6096. As a metal target 6098, such as a metal staple, isintroduced into the electromagnetic field 6096, eddy currents 6100induced in the target 6098 oppose the electromagnetic field 6096 and thereluctance shifts and the amplitude of the oscillator voltage 6102drops. An amplifier 6104 amplifies the oscillator voltage 6102 amplitudeas it changes.

With reference now to FIGS. 1-11 to show interaction with an interactivesurgical system 100 environment including a surgical hub 106, 206 andalso to FIGS. 106-117 , the inductive sensor 6090 is a non-contactelectronic sensor. It can be used for positioning and detecting metalobjects such as the metal staples in the staple lines 6003, 6004, 6052described above. The sensing range of the inductive sensor 6090 isdependent on the type of metal being detected. Because the inductivesensor 6090 is a non-contact sensor, it can detect metal objects acrossa stapled tissue barrier. The inductive sensor 6090 can be locatedeither on the circular stapler 6002 to detect staples in the staplelines 6003, 6004, 6052, detect the location of the distal end of thelaparoscope 6014, or it may be located on the laparoscope 6014 to detectthe location of the anvil trocar 6010. A processor or control circuitlocated either in the circular stapler 6002, laparoscope 6014, orcoupled to the surgical hub 206 receives signals from the inductivesensors 6090 and can be employed to display the centering tool on thesurgical hub display 215 to determine the location of the anvil trocar6010 relative to either staple overlap portion 6012 of a double stapleline 6004 or the center 6050 of a linear staple line 6052.

In one aspect, the distal end of the laparoscope 6014 may be detected bythe inductive sensor 6090 located on the circular stapler 6002. Theinductive sensor 6090 may detect a metal target 6098 positioned on thedistal end of the laparoscope 6014. Once the laparoscope 6014 is alignedwith the center 6050 of the linear staple line 6052 or the stapleoverlap portion 6012 of the double staple line 6004, a signal from theinductive sensor 6090 is transmitted to circuits that convert thesignals from the inductive sensor 6090 to present an image of therelative alignment of the laparoscope 6014 with the anvil trocar 6010 ofthe circular stapler 6002.

FIGS. 119A and 119B illustrate one aspect of a non-contact capacitivesensor 6110 implementation of the non-contact sensor 6022 to determinean anvil trocar 6010 location relative to the center of a staple linetransection (the staple overlap portion 6012 of the double staple line6004 shown in FIGS. 107-108 or the center 6050 of the linear staple line6052 shown in FIGS. 112-113 , for example), according to one aspect ofthe present disclosure. FIG. 119A shows the non-contact capacitivesensor 6110 without a nearby metal target and FIG. 119B shows thenon-contact capacitive sensor 6110 near a metal target 6112. Thenon-contact capacitive sensor 6110 includes capacitor plates 6114, 6116housed in a sensing head and establishes field lines 6118 when energizedby an oscillator waveform to define a sensing zone. FIG. 119A shows thefield lines 6118 when no target is present proximal to the capacitorplates 6114, 6116. FIG. 119B shows a ferrous or nonferrous metal target6120 in the sensing zone. As the metal target 6120 enters the sensingzone, the capacitance increases causing the natural frequency to shifttowards the oscillation frequency causing amplitude gain. Because thecapacitive sensor 6110 is a non-contact sensor, it can detect metalobjects across a stapled tissue barrier. The capacitive sensor 6110 canbe located either on the circular stapler 6002 to detect the staplelines 6004, 6052 or the location of the distal end of the laparoscope6014 or the capacitive sensor 6110 may be located on the laparoscope6014 to detect the location of the anvil trocar 6010. A processor orcontrol circuit located either in the circular stapler 6002, thelaparoscope 6014, or coupled to the surgical hub 206 receives signalsfrom the capacitive sensor 6110 to present an image of the relativealignment of the laparoscope 6014 with the anvil trocar 6010 of thecircular stapler 6002.

FIG. 120 is a logic flow diagram 6130 of a process depicting a controlprogram or a logic configuration for aligning a surgical instrument,according to one aspect of the present disclosure. With reference toFIGS. 1-11 to show interaction with an interactive surgical system 100environment including a surgical hub 106, 206 and also to FIGS. 106-119, the surgical hub 206 comprises a processor 244 and a memory 249coupled to the processor 244. The memory 249 stores instructionsexecutable by the processor 244 to receive 6132 image data from alaparoscope image sensor, generate 6134 a first image based on the imagedata, display 6136 the first image on a surgical hub display 215 coupledto the processor 244, receive 6138 a signal from a non-contact sensor6022, the signal indicative of a position of a surgical device, generatea second image based on the signal indicative of the position of thesurgical device, e.g., the anvil trocar 6010 and display 6140 the secondimage on the surgical hub display 215. The first image data represents acenter 6044, 6050 of a staple line 6004, 6052 seal. The first imagerepresents a target corresponding to the center 6044, 6050 of the stapleline 6004, 6052 seal. The signal is indicative of a position of asurgical device, e.g., an anvil trocar 6010, relative to the center6044, 6050 of the staple line 6004, 6052 seal. The second imagerepresents the position of the surgical device, e.g., an anvil trocar6010, along a projected path 6018 of the surgical device, e.g., an anviltrocar 6010, toward the center 6044, 6050 of the staple line 6004, 6052seal.

In one aspect, the center 6044 of the double staple line 6004 sealdefines a staple overlap portion 6012. In another aspect, an imagesensor receives an image from a medical imaging device. In anotheraspect, the surgical device is a circular stapler 6002 comprising ananvil trocar 6010 and the non-contact sensor 6022 is configured todetect the location of the anvil trocar 6010 relative to the center 6044of the double staple line 6004 seal. In another aspect, the non-contactsensor 6022 is an inductive sensor 6090. In another aspect, thenon-contact sensor 6022 is a capacitive sensor 6110. In one aspect, thestaple line may be a linear staple line 6052 formed using a lineartransection technique.

Cooperation Between Local Instrument Displays and Paired Imaging DeviceDisplay

In one aspect, the present disclosure provides an instrument including alocal display, a hub having an operating room (OR), or operatingtheater, display separate from the instrument display. When theinstrument is linked to the surgical hub, the secondary display on thedevice reconfigures to display different information than when it isindependent of the surgical hub connection. In another aspect, someportion of the information on the secondary display of the instrument isthen displayed on the primary display of the surgical hub. In anotheraspect, image fusion allowing the overlay of the status of a device, theintegration landmarks being used to interlock several images and atleast one guidance feature are provided on the surgical hub and/orinstrument display. Techniques for overlaying or augmenting imagesand/or text from multiple image/text sources to present composite imageson a single display are described hereinbelow in connection with FIGS.129-137 and FIGS. 147-151 .

In another aspect, the present disclosure provides cooperation betweenlocal instrument displays and a paired laparoscope display. In oneaspect, the behavior of a local display of an instrument changes when itsenses the connectable presence of a global display coupled to thesurgical hub. In another aspect, the present disclosure provides 360°composite top visual field of view of a surgical site to avoidcollateral structures. Each of these techniques is describedhereinbelow.

During a surgical procedure, the surgical site is displayed on a remote“primary” surgical hub display. During a surgical procedure, surgicaldevices track and record surgical data and variables (e.g., surgicalparameters) that are stored in the instrument (see FIGS. 12-19 forinstrument architectures comprising processors, memory, controlcircuits, storage, etc.). The surgical parameters include force-to-fire(FTF), force-to-close (FTC), firing progress, tissue gap, power level,impedance, tissue compression stability (creep), and the like. Usingconventional techniques during the procedure the surgeon needs to watchtwo separate displays. Providing image/text overlay is thus advantageousbecause during the procedure the surgeon can watch a single displaypresenting the overlaid image/text information.

One solution detects when the surgical device (e.g., instrument) isconnected to the surgical hub and then display a composite image on theprimary display that includes a field of view of the surgical sitereceived from a first instrument (e.g., medical imaging device such as,e.g., laparoscope, endoscope, thoracoscope, and the like) augmented bysurgical data and variables received from a second instrument (e.g., asurgical stapler) to provide pertinent images and data on the primarydisplay.

During a surgical procedure the surgical site is displayed as a narrowfield of view of a medical imaging device on the primary surgical hubdisplay. Items outside the current field of view, collateral structures,cannot be viewed without moving the medical imaging device.

One solution provides a narrow field of view of the surgical site in afirst window of the display augmented by a wide field of view of thesurgical site in a separate window of the display. This provides acomposite over head field of view mapped using two or more imagingarrays to provide an augmented image of multiple perspective views ofthe surgical site.

In one aspect, the present disclosure provides a surgical hub,comprising a processor and a memory coupled to the processor. The memorystores instructions executable by the processor to detect a surgicaldevice connection to the surgical hub, transmit a control signal to thedetected surgical device to transmit to the surgical hub surgicalparameter data associated with the detected device, receive the surgicalparameter data, receive image data from an image sensor, and display, ona display coupled to the surgical hub, an image received from the imagesensor in conjunction with the surgical parameter data received from thesurgical device.

In another aspect, the present disclosure provides a surgical hub,comprising a processor and a memory coupled to the processor. The memorystores instructions executable by the processor to receive first imagedata from a first image sensor, receive second image data from a secondimage sensor, and display, on a display coupled to the surgical hub, afirst image corresponding to the first field of view and a second imagecorresponding to the second field of view. The first image datarepresents a first field of view and the second image data represents asecond field of view.

In one aspect, the first field of view is a narrow angle field of viewand the second field of view is a wide angle field of view. In anotheraspect, the memory stores instructions executable by the processor toaugment the first image with the second image on the display. In anotheraspect, the memory stores instructions executable by the processor tofuse the first image and the second image into a third image and displaya fused image on the display. In another aspect, the fused image datacomprises status information associated with a surgical device, an imagedata integration landmark to interlock a plurality of images, and atleast one guidance parameter. In another aspect, the first image sensoris the same as the same image sensor and wherein the first image data iscaptured as a first time and the second image data is captured at asecond time.

In another aspect, the memory stores instructions executable by theprocessor to receive third image data from a third image sensor, whereinthe third image data represents a third field of view, generatecomposite image data comprising the second and third image data, displaythe first image in a first window of the display, wherein the firstimage corresponds to the first image data, and display a third image ina second window of the display, wherein the third image corresponds tothe composite image data.

In another aspect, the memory stores instructions executable by theprocessor to receive third image data from a third image sensor, whereinthe third image data represents a third field of view, fuse the secondand third image data to generate fused image data, display the firstimage in a first window of the display, wherein the first imagecorresponds to the first image data, and display a third image in asecond window of the display, wherein the third image corresponds to thefused image data.

In various aspects, the present disclosure provides a control circuit toperform the functions described above. In various aspects, the presentdisclosure provides a non-transitory computer readable medium storingcomputer readable instructions, which when executed, causes a machine toperform the functions described above.

By displaying endoscope images augmented with surgical device images onone primary surgical hub display, enables the surgeon to focus on onedisplay to obtain a field of view of the surgical site augmented withsurgical device data associated with the surgical procedure such asforce-to-fire, force-to-close, firing progress, tissue gap, power level,impedance, tissue compression stability (creep), and the like.

Displaying a narrow field of view image in a first window of a displayand a composite image of several other perspectives such as wider fieldsof view enables the surgeon to view a magnified image of the surgicalsite simultaneously with wider fields of view of the surgical sitewithout moving the scope.

In one aspect, the present disclosure provides both global and localdisplay of a device, e.g., a surgical instrument, coupled to thesurgical hub. The device displays all of its relevant menus and displayson a local display until it senses a connection to the surgical hub atwhich point a sub-set of the information is displayed only on themonitor through the surgical hub and that information is either mirroredon the device display or is no longer accessible on the device detonatedscreen. This technique frees up the device display to show differentinformation or display larger font information on the surgical hubdisplay.

In one aspect, the present disclosure provides an instrument having alocal display, a surgical hub having an operating theater (e.g.,operating room or OR) display that is separate from the instrumentdisplay. When the instrument is linked to the surgical hub, theinstrument local display becomes a secondary display and the instrumentreconfigures to display different information than when it is operatingindependent of the surgical hub connection. In another aspect, someportion of the information on the secondary display is then displayed onthe primary display in the operating theater through the surgical hub.

FIG. 121 illustrates a primary display 6200 of the surgical hub 206comprising a global display 6202 and a local instrument display 6204,according to one aspect of the present disclosure. With continuedreference to FIGS. 1-11 to show interaction with an interactive surgicalsystem 100 environment including a surgical hub 106, 206 and FIGS. 12-21for surgical hub connected instruments together with FIG. 121 , thelocal instrument display 6204 behavior is displayed when the instrument235 senses the connectable presence of a global display 6202 through thesurgical hub 206. The global display 6202 shows a field of view 6206 ofa surgical site 6208, as viewed through a medical imaging device suchas, for example, a laparoscope/endoscope 219 coupled to an imagingmodule 238, at the center of the surgical hub display 215, referred toherein also as a monitor, for example. The end effector 6218 portion ofthe connected instrument 235 is shown in the field of view 6206 of thesurgical site 6208 in the global display 6202. The images shown on thedisplay 237 located on an instrument 235 coupled to the surgical hub 206is shown, or mirrored, on the local instrument display 6204 located inthe lower right corner of the monitor 6200 as shown in FIG. 121 , forexample. During operation, all relevant instrument and information andmenus are displayed on the display 237 located on the instrument 235until the instrument 235 senses a connection of the instrument 235 tothe surgical hub 206 at which point all or some sub-set of theinformation presented on the instrument display 237 is displayed only onthe local instrument display 6204 portion of the surgical hub display6200 through the surgical hub 206. The information displayed on thelocal instrument display 6204 may be mirrored on the display 237 locatedon the instrument 235 or may be no longer accessible on the instrumentdisplay 237 detonated screen. This technique frees up the instrument 235to show different information or to show larger font information on thesurgical hub display 6200. Several techniques for overlaying oraugmenting images and/or text from multiple image/text sources topresent composite images on a single display are described hereinbelowin connection with FIGS. 129-137 and FIGS. 147-151 .

The surgical hub display 6200 provides perioperative visualization ofthe surgical site 6208. Advanced imaging identifies and visuallyhighlights 6222 critical structures such as the ureter 6220 (or nerves,etc.) and also tracks instrument proximity displays 6210 and shown onthe left side of the display 6200. In the illustrated example, theinstrument proximity displays 6210 show instrument specific settings.For example the top instrument proximity display 6212 shows settings fora monopolar instrument, the middle instrument proximity display 6214shows settings for a bipolar instrument, and the bottom instrumentproximity display 6212 shows settings for an ultrasonic instrument.

In another aspect, independent secondary displays or dedicated localdisplays can be linked to the surgical hub 206 to provide both aninteraction portal via a touchscreen display and/or a secondary screenthat can display any number of surgical hub 206 tracked data feeds toprovide a clear non-confusing status. The secondary screen may displayforce to fire (FTF), tissue gap, power level, impedance, tissuecompression stability (creep), etc., while the primary screen maydisplay only key variables to keep the feed free of clutter. Theinteractive display may be used to move the display of specificinformation to the primary display to a desired location, size, color,etc. In the illustrated example, the secondary screen displays theinstrument proximity displays 6210 on the left side of the display 6200and the local instrument display 6204 on the bottom right side of thedisplay 6200. The local instrument display 6204 presented on thesurgical hub display 6200 displays an icon of the end effector 6218,such as the icon of a staple cartridge 6224 currently in use, the size6226 of the staple cartridge 6224 (e.g., 60 mm), and an icon of thecurrent position of the knife 6228 of the end effector.

In another aspect, the display 237 located on the instrument 235displays the wireless or wired attachment of the instrument 235 to thesurgical hub 206 and the instrument's communication/recording on thesurgical hub 206. A setting may be provided on the instrument 235 toenable the user to select mirroring or extending the display to bothmonitoring devices. The instrument controls may be used to interact withthe surgical hub display of the information being sourced on theinstrument. As previously discussed, the instrument 235 may comprisewireless communication circuits to communicate wirelessly with thesurgical hub 206.

In another aspect, a first instrument coupled to the surgical hub 206can pair to a screen of a second instrument coupled to the surgical hub206 allowing both instruments to display some hybrid combination ofinformation from the two devices of both becoming mirrors of portions ofthe primary display. In yet another aspect, the primary display 6200 ofthe surgical hub 206 provides a 360° composite top visual view of thesurgical site 6208 to avoid collateral structures. For example, asecondary display of the end-effector surgical stapler may be providedwithin the primary display 6200 of the surgical hub 206 or on anotherdisplay in order to provide better perspective around the areas within acurrent the field of view 6206. These aspects are described hereinbelowin connection with FIGS. 122-124 .

FIGS. 122-124 illustrate a composite overhead views of an end-effector6234 portion of a surgical stapler mapped using two or more imagingarrays or one array and time to provide multiple perspective views ofthe end-effector 6234 to enable the composite imaging of an overheadfield of view. The techniques described herein may be applied toultrasonic instruments, electrosurgical instruments, combinationultrasonic/electrosurgical instruments, and/or combination surgicalstapler/electrosurgical instruments. Several techniques for overlayingor augmenting images and/or text from multiple image/text sources topresent composite images on a single display are described hereinbelowin connection with FIGS. 129-137 and FIGS. 147-151 .

FIG. 122 illustrates a primary display 6200 of the surgical hub 206,according to one aspect of the present disclosure. A primary window 6230is located at the center of the screen shows a magnified or explodednarrow angle view of a surgical field of view 6232. The primary window6230 located in the center of the screen shows a magnified or narrowangle view of an end-effector 6234 of the surgical stapler grasping avessel 6236. The primary window 6230 displays knitted images to producea composite image that enables visualization of structures adjacent tothe surgical field of view 6232. A second window 6240 is shown in thelower left corner of the primary display 6200. The second window 6240displays a knitted image in a wide angle view at standard focus of theimage shown in the primary window 6230 in an overhead view. The overheadview provided in the second window 6240 enables the viewer to easily seeitems that are out of the narrow field surgical field of view 6232without moving the laparoscope, or other imaging device 239 coupled tothe imaging module 238 of the surgical hub 206. A third window 6242 isshown in the lower right corner of the primary display 6200 shows anicon 6244 representative of the staple cartridge of the end-effector6234 (e.g., a staple cartridge in this instance) and additionalinformation such as “4 Row” indicating the number of staple rows 6246and “35 mm” indicating the distance 6248 traversed by the knife alongthe length of the staple cartridge. Below the third window 6242 isdisplayed an icon 6258 of a frame of the current state of a clampstabilization sequence 6250 (FIG. 123 ) that indicates clampstabilization.

FIG. 123 illustrates a clamp stabilization sequence 6250 over a fivesecond period, according to one aspect of the present disclosure. Theclamp stabilization sequence 6250 is shown over a five second periodwith intermittent displays 6252, 6254, 6256, 6258, 6260 spaced apart atone second intervals 6268 in addition to providing the real time 6266(e.g., 09:35:10), which may be a pseudo real time to preserve anonymityof the patient. The intermittent displays 6252, 6254, 6256, 6258, 6260show elapsed by filling in the circle until the clamp stabilizationperiod is complete. At that point, the last display 6260 is shown insolid color. Clamp stabilization after the end effector 6234 clamps thevessel 6236 enables the formation of a better seal.

FIG. 124 illustrates a diagram 6270 of four separate wide angle viewimages 6272, 6274, 6276, 6278 of a surgical site at four separate timesduring the procedure, according to one aspect of the present disclosure.The sequence of images shows the creation of an overhead composite imagein wide and narrow focus over time. A first image 6272 is a wide angleview of the end-effector 6234 clamping the vessel 6236 taken at anearlier time t_(o) (e.g., 09:35:09). A second image 6274 is another wideangle view of the end-effector 6234 clamping the vessel 6236 taken atthe present time t₁ (e.g., 09:35:13). A third image 6276 is a compositeimage of an overhead view of the end-effector 6234 clamping the vessel6236 taken at present time t₁. The third image 6276 is displayed in thesecond window 6240 of the primary display 6200 of the surgical hub 206as shown in FIG. 122 . A fourth image 6278 is a narrow angle view of theend-effector 6234 clamping the vessel 6236 at present time t₁ (e.g.,09:35:13). The fourth image 6278 is the narrow angle view of thesurgical site shown in the primary window 6230 of the primary display6200 of the surgical hub 206 as shown in FIG. 122 .

Display of Instrument Specific Data Needed for Efficient Use of theEnd-Effector

In one aspect, the present disclosure provides a surgical hub display ofinstrument specific data needed for efficient use of a surgicalinstrument, such as a surgical stapler. The techniques described hereinmay be applied to ultrasonic instruments, electrosurgical instruments,combination ultrasonic/electrosurgical instruments, and/or combinationsurgical stapler/electrosurgical instruments. In one aspect, a clamptime indicator based on tissue properties is shown on the display. Inanother aspect, a 360° composite top visual view is shown on the displayto avoid collateral structures as shown and described in connection withFIGS. 121-124 is incorporated herein by reference and, for concisenessand clarity of disclosure, the description of FIGS. 121-124 will not berepeated here.

In one aspect, the present disclosure provides a display of tissue creepto provide the user with in-tissue compression/tissue stability data andto guide the user making an appropriate choice of when to conduct thenext instrument action. In one aspect, an algorithm calculates aconstant advancement of a progressive time based feedback system relatedto the viscoelastic response of tissue. These and other aspects aredescribed hereinbelow.

FIG. 125 is a graph 6280 of tissue creep clamp stabilization curves6282, 6284 for two tissue types, according to one aspect of the presentdisclosure. The clamp stabilization curves 6284, 6284 are plotted asforce-to-close (FTC) as a function of time, where FTC (N) is displayedalong the vertical axis and Time, t, (Sec) is displayed along thehorizontal axis. The FTC is the amount of force exerted to close theclamp arm on the tissue. The first clamp stabilization curve 6282represents stomach tissue and the second clamp stabilization curve 6284represents lung tissue. In one aspect, the FTC along the vertical axisis scaled from 0-180 N. and the horizontal axis is scaled from 0-5 Sec.As shown, the FTC as a different profile over a five second clampstabilization period (e.g., as shown in FIG. 123 ).

With reference to the first clamp stabilization curve 6282, as thestomach tissue is clamped by the end-effector 6234, the force-to-close(FTC) applied by the end-effector 6234 increases from 0 N to a peakforce-to-close of ˜180 N after ˜1 Sec. While the end-effector 6234remains clamped on the stomach tissue, the force-to-close decays andstabilizes to ˜150 N over time due to tissue creep.

Similarly, with reference to the second clamp stabilization curve 6284,as the lung tissue is clamped by the end-effector 6234, theforce-to-close applied by the end-effector 6234 increases from 0 N to apeak force-to-close of ˜90 N after just less than ˜1 Sec. While theend-effector 6234 remains clamped on the lung tissue, the force-to-closedecays and stabilizes to ˜60 N over time due to tissue creep.

The end-effector 6234 clamp stabilization is monitored as describedabove in connection with FIGS. 122-124 and is displayed every secondcorresponding the sampling times t₁, t₂, t₃, t₄, t₅ of theforce-to-close to provide user feedback regarding the state of theclamped tissue. FIG. 125 shows an example of monitoring tissuestabilization for the lung tissue by sampling the force-to-close everysecond over a 5 seconds period. At each sample time t₁, t₂, t₃, t₄, t₅,the instrument 235 or the surgical hub 206 calculates a correspondingvector tangent 6288, 6292, 6294, 6298, 6302 to the second clampstabilization curve 6284. The vector tangent 6288, 6292, 6294, 6298,6302 is monitored until its slope drops below a threshold to indicatethat the tissue creep is complete and the tissue is ready to sealed andcut. As shown in FIG. 125 , the lung tissue is ready to be sealed andcut after ˜5 Sec. clamp stabilization period, where a solid gray circleis shown at sample time 6300. As shown, the vector tangent 6302 is lessthan a predetermined threshold.

The equation of a vector tangent 6288, 6292, 6294, 6298, 6302 to theclamp stabilization curve 6284 may be calculated using differentialcalculus techniques, for example. In one aspect, at a given point on theclamp stabilization curve 6284, the gradient of the curve 6284 is equalto the gradient of the tangent to the curve 6284. The derivative (orgradient function) describes the gradient of the curve 6284 at any pointon the curve 6284. Similarly, it also describes the gradient of atangent to the curve 6284 at any point on the curve 6284. The normal tothe curve 6284 is a line perpendicular to the tangent to the curve 6284at any given point. To determine the equation of a tangent to a curvefind the derivative using the rules of differentiation. Substitute the xcoordinate (independent variable) of the given point into the derivativeto calculate the gradient of the tangent. Substitute the gradient of thetangent and the coordinates of the given point into an appropriate formof the straight line equation. Make the y coordinate (dependentvariable) the subject of the formula.

FIG. 126 is a graph 6310 of time dependent proportionate fill of a clampforce stabilization curve, according to one aspect of the presentdisclosure. The graph 6310 includes clamp stabilization curves 6312,6314, 6316 for standard thick stomach tissue, thin stomach tissue, andstandard lung tissue. The vertical axis represents FTC (N) scaled from0-240 N and the horizontal axis represents Time, t, (Sec) scaled from0-15 Sec. As shown, the standard thick stomach tissue curve 6316 is thedefault force decay stability curve. All three clamp stabilizationcurves 6312, 6314, 6316 FTC profiles reach a maximum force shortly afterclamping on the tissue and then the FTC decreases over time until iteventually stabilizes due to the viscoelastic response of the tissue. Asshown the standard lung tissue clamp stabilization curve 6312 stabilizesafter a period of ˜5 Sec., the thin stomach tissue clamp stabilizationcurve 6314 stabilizes after a period of ˜10 Sec., and the thick stomachtissue clamp stabilization curve 6316 stabilizes after a period of ˜15Sec.

FIG. 127 is a graph 6320 of the role of tissue creep in the clamp forcestabilization curve 6322, according to one aspect of the presentdisclosure. The vertical axis represents force-to-close FTC (N) and thehorizontal axis represents Time, t, (Sec) in seconds. Vector tangentangles dθ₁, dθ₂ . . . dθ_(n) are measured at each force-to-closesampling (t₀, t₁, t₂, t₃, t₄, etc.) times. The vector tangent angledθ_(n) is used to determine when the tissue has reached the creeptermination threshold, which indicates that the tissue has reached creepstability.

FIGS. 128A and 128B illustrate two graphs 6330, 6340 for determiningwhen the clamped tissue has reached creep stability, according to oneaspect of the present disclosure. The graph 6330 in FIG. 128Aillustrates a curve 6332 that represents a vector tangent angle dθ as afunction of time. The vector tangent angle dθ is calculated as discussedin FIG. 127 . The horizontal line 6334 is the tissue creep terminationthreshold. The tissue creep is deemed to be stable at the intersection6336 of the vector tangent angle dθ curve 6332 and the tissue creeptermination threshold 6334. The graph 6340 in FIG. 128B illustrates aΔFTC curve 6342 that represents ΔFTC as a function of time. The ΔFTCcurve 6342 illustrates the threshold 6344 to 100% complete tissue creepstability meter. The tissue creep is deemed to be stable at theintersection 6346 of the ΔFTC curve 6342 and the threshold 6344.

Communication Techniques

With reference to FIGS. 1-11 to show interaction with an interactivesurgical system 100 environment including a surgical hub 106, 206, andin particular, FIGS. 9-10 , in various aspects, the present disclosureprovides communications techniques for exchanging information between aninstrument 235, or other modules, and the surgical hub 206. In oneaspect, the communications techniques include image fusion to placeinstrument status and analysis over a laparoscope image, such as ascreen overlay of data, within and around the perimeter of an imagepresented on a surgical hub display 215, 217. In another aspect, thecommunication techniques include combining an intermediate short rangewireless, e.g., Bluetooth, signal with the image, and in another aspect,the communication techniques include applying security andidentification of requested pairing. In yet another aspect, thecommunication techniques include an independent interactive headset wornby a surgeon that links to the hub with audio and visual informationthat avoids the need for overlays, but allows customization of displayedinformation around periphery of view. Each of these communicationtechniques is discussed hereinbelow.

Screen Overlay of Data within and Around the Perimeter of the DisplayedImage

In one aspect, the present disclosure provides image fusion allowing theoverlay of the status of a device, the integration landmarks being usedto interlock several images, and at least one guidance feature. Inanother aspect, the present disclosure provides a technique for screenoverlay of data within and around the perimeter of displayed image.Radiographic integration may be employed for live internal sensing andpre-procedure overlay. Image fusion of one source may be superimposedover another. Image fusion may be employed to place instrument statusand analysis on a medical imaging device (e.g., laparoscope, endoscope,thoracoscope, etc.) image. Image fusion allows the overlay of the statusof a device or instrument, integration landmarks to interlock severalimages, and at least one guidance feature.

FIG. 129 illustrates an example of an augmented video image 6350comprising a pre-operative video image 6352 augmented with data 6354,6356, 6358 identifying displayed elements. An augmented reality visionsystem may be employed in surgical procedures to implement a method foraugmenting data onto a pre-operative image 6352. The method includesgenerating a pre-operative image 6352 of an anatomical section of apatient and generating an augmented video image of a surgical sitewithin the patient. The augmented video image 6350 includes an image ofat least a portion of a surgical tool 6354 operated by a user 6456. Themethod further includes processing the pre-operative image 6352 togenerate data about the anatomical section of the patient. The dataincludes a label 6358 for the anatomical section and a peripheral marginof at least a portion of the anatomical section. The peripheral marginis configured to guide a surgeon to a cutting location relative to theanatomical section, embedding the data and an identity of the user 6356within the pre-operative image 6350 to display an augmented video image6350 to the user about the anatomical section of the patient. The methodfurther includes sensing a loading condition on the surgical tool 6354,generating a feedback signal based on the sensed loading condition, andupdating, in real time, the data and a location of the identity of theuser operating the surgical tool 6354 embedded within the augmentedvideo image 6350 in response to a change in a location of the surgicaltool 6354 within the augmented video image 6350. Further examples aredisclosed in U.S. Pat. No. 9,123,155, entitled APPARATUS AND METHOD FORUSING AUGMENTED REALITY VISION SYSTEM IN SURGICAL PROCEDURES, whichissued on Sep. 1, 2015, which is herein incorporated by reference in itsentirety.

In another aspect, radiographic integration techniques may be employedto overlay the pre-operative image 6352 with data obtained through liveinternal sensing or pre-procedure techniques. Radiographic integrationmay include marker and landmark identification using surgical landmarks,radiographic markers placed in or outside the patient, identification ofradio-opaque staples, clips or other tissue-fixated items. Digitalradiography techniques may be employed to generate digital images foroverlaying with a pre-operative image 6352. Digital radiography is aform of X-ray imaging that employs a digital image capture device withdigital X-ray sensors instead of traditional photographic film. Digitalradiography techniques provide immediate image preview and availabilityfor overlaying with the pre-operative image 6352. In addition, specialimage processing techniques can be applied to the digital X-ray mages toenhance the overall display quality of the image.

Digital radiography techniques employ image detectors that include flatpanel detectors (FPDs), which are classified in two main categoriesindirect FPDs and direct FPDs. Indirect FPDs include amorphous silicon(a-Si) combined with a scintillator in the detector's outer layer, whichis made from cesium iodide (CsI) or gadolinium oxy-sulfide (Gd2O2S),converts X-rays to light. The light is channeled through the a-Siphotodiode layer where it is converted to a digital output signal. Thedigital signal is then read out by thin film transistors (TFTs) orfiber-coupled charge coupled devices (CCDs). Direct FPDs includeamorphous selenium (a-Se) FPDs that convert X-ray photons directly intocharge. The outer layer of a flat panel in this design is typically ahigh-voltage bias electrode. X-ray photons create electron-hole pairs ina-Se, and the transit of these electrons and holes depends on thepotential of the bias voltage charge. As the holes are replaced withelectrons, the resultant charge pattern in the selenium layer is readout by a TFT array, active matrix array, electrometer probes or microplasma line addressing. Other direct digital detectors are based on CMOSand CCD technology. Phosphor detectors also may be employed to recordthe X-ray energy during exposure and is scanned by a laser diode toexcite the stored energy which is released and read out by a digitalimage capture array of a CCD.

FIG. 130 is a logic flow diagram 6360 of a process depicting a controlprogram or a logic configuration to display images, according to oneaspect of the present disclosure. With reference also to FIGS. 1-11 toshow interaction with an interactive surgical system 100 environmentincluding a surgical hub 106, 206, the present disclosure provides, inone aspect, a surgical hub 206, comprising a processor 244 and a memory249 coupled to the processor 244. The memory 249 stores instructionsexecutable by the processor 244 to receive 6362 first image data from afirst image sensor, receive 6364 second image data from a second imagesensor, and display 6366, on a display 217 coupled to the surgical hub206, a first image corresponding to the first field of view and a secondimage corresponding to the second field of view. The first image datarepresents a first field of view and the second image data represents asecond field of view.

In one aspect, the first field of view is a narrow angle field of viewand the second field of view is a wide angle field of view. In anotheraspect, the memory 249 stores instructions executable by the processor244 to augment the first image with the second image on the display. Inanother aspect, the memory 249 stores instructions executable by theprocessor 244 to fuse the first image and the second image into a thirdimage and display a fused image on the display 217. In another aspect,the fused image data comprises status information associated with asurgical device 235, an image data integration landmark to interlock aplurality of images, and at least one guidance parameter. In anotheraspect, the first image sensor is the same as the same image sensor andwherein the first image data is captured as a first time and the secondimage data is captured at a second time.

In another aspect, the memory 249 stores instructions executable by theprocessor 244 to receive third image data from a third image sensor,wherein the third image data represents a third field of view, generatecomposite image data comprising the second and third image data, displaythe first image in a first window of the display, wherein the firstimage corresponds to the first image data, and display a third image ina second window of the display 215, wherein the third image correspondsto the composite image data.

In another aspect, the memory 249 stores instructions executable by theprocessor 244 to receive third image data from a third image sensor,wherein the third image data represents a third field of view, fuse thesecond and third image data to generate fused image data, display thefirst image in a first window of the display 217, wherein the firstimage corresponds to the first image data, and display a third image ina second window of the display 217, wherein the third image correspondsto the fused image data.

Intermediate Short Range Wireless (e.g., Bluetooth) Signal Combiner

An intermediate short range wireless, e.g., Bluetooth, signal combinermay comprise a wireless heads-up display adapter placed into thecommunication path of the monitor to a laparoscope console allowing thesurgical hub to overlay data onto the screen. Security andidentification of requested pairing may augment the communicationtechniques.

FIG. 131 illustrates a communication system 6370 comprising anintermediate signal combiner 6372 positioned in the communication pathbetween an imaging module 238 and a surgical hub display 217, accordingto one aspect of the present disclosure. The signal combiner 6372receives image data from an imaging module 238 in the form of shortrange wireless or wired signals. The signal combiner 6372 also receivesaudio and image data form a headset 6374 and combines the image datafrom the imaging module 238 with the audio and image data from theheadset 6374. The surgical hub 206 receives the combined data from thecombiner 6372 and overlays the data provided to the display 217, wherethe overlaid data is displayed. The signal combiner 6372 may communicatewith the surgical hub 206 via wired or wireless signals. The headset6374 receives image data from an imaging device 6376 coupled to theheadset 6374 and receives audio data from an audio device 6378 coupledto the headset 6374. The imaging device 6376 may be a digital videocamera and the audio device 6378 may be a microphone. In one aspect, thesignal combiner 6372 may be an intermediate short range wireless, e.g.,Bluetooth, signal combiner. The signal combiner 6374 may comprise awireless heads-up display adapter to couple to the headset 6374 placedinto the communication path of the display 217 to a console allowing thesurgical hub 206 to overlay data onto the screen of the display 217.Security and identification of requested pairing may augment thecommunication techniques. The imaging module 238 may be coupled to avariety if imaging devices such as an endoscope 239, laparoscope, etc.,for example.

Independent Interactive Headset

FIG. 132 illustrates an independent interactive headset 6380 worn by asurgeon 6382 to communicate data to the surgical hub, according to oneaspect of the present disclosure. Peripheral information of theindependent interactive headset 6380 does not include active video.Rather, the peripheral information includes only device settings, orsignals that do not have same demands of refresh rates. Interaction mayaugment the surgeon's 6382 information based on linkage withpreoperative computerized tomography (CT) or other data linked in thesurgical hub 206. The independent interactive headset 6380 can identifystructure—ask whether instrument is touching a nerve, vessel, oradhesion, for example. The independent interactive headset 6380 mayinclude pre-operative scan data, an optical view, tissue interrogationproperties acquired throughout procedure, and/or processing in thesurgical hub 206 used to provide an answer. The surgeon 6382 can dictatenotes to the independent interactive headset 6380 to be saved withpatient data in the hub storage 248 for later use in report or in followup.

In one aspect, the independent interactive headset 6380 worn by thesurgeon 6382 links to the surgical hub 206 with audio and visualinformation to avoid the need for overlays, and allows customization ofdisplayed information around periphery of view. The independentinteractive headset 6380 provides signals from devices (e.g.,instruments), answers queries about device settings, or positionalinformation linked with video to identify quadrant or position. Theindependent interactive headset 6380 has audio control and audiofeedback from the headset 6380. The independent interactive headset 6380is still able to interact with all other systems in the operatingtheater (e.g., operating room), and have feedback and interactionavailable wherever the surgeon 6382 is viewing.

Identification and Usage Recording

In one aspect, the present disclosure provides a display of theauthenticity of reloads, modular components, or loading units. FIG. 133illustrates a method 6390 for controlling the usage of a device 6392. Adevice 6392 is connected to an energy source 6394. The device 6392includes a memory device 6396 that includes storage 6398 andcommunication 6400 devices. The storage 6398 includes data 6402 that maybe locked data 6404 or unlocked data 6406. Additionally, the storage6398 includes an error-detecting code 6408 such as a cyclic redundancycheck (CRC) value and a sterilization indicator 6410. The energy source6394 includes a reader 6412, display 6414, a processor 6416, and a dataport 6418 that couples the energy source 6394 to a network 6420. Thenetwork 6420 is coupled to a central server 6422, which is coupled to acentral database 6424. The network 6420 also is coupled to areprocessing facility 6426. The reprocessing facility 6426 includes areprocessing data reader/writer 6428 and a sterilizing device 6430.

The method comprises connecting the device to an energy source 6394.Data is read from a memory device 6396 incorporated in the device 6392.The data including one or more of a unique identifier (UID), a usagevalue, an activation value, a reprocessing value, or a sterilizationindicator. The usage value is incremented when the device 6392 isconnected to the energy source 6394. The activation value is incrementedwhen the device 6392 is activated permitting energy to flow from theenergy source 6394 to an energy consuming component of the device 6392.Usage of the device 6392 may be prevented if: the UID is on a list ofprohibited UIDs, the usage value is not lower than a usage limitationvalue, the reprocessing value is equal to a reprocessing limitationvalue, the activation value is equal to an activation limitation value,and/or the sterilization indicator does not indicate that the device hasbeen sterilized since its previous usage. Further examples are disclosedin U.S. Patent Application Publication No. 2015/0317899, entitled SYSTEMAND METHOD FOR USING RFID TAGS TO DETERMINE STERILIZATION OF DEVICES,which published on Nov. 5, 2015, which is herein incorporated byreference in its entirety.

FIG. 134 provides a surgical system 6500 in accordance with the presentdisclosure and includes a surgical instrument 6502 that is incommunication with a console 6522 or a portable device 6526 through alocal area network 6518 or a cloud network 6520 via a wired or wirelessconnection. In various aspects, the console 6522 and the portable device6526 may be any suitable computing device. The surgical instrument 6502includes a handle 6504, an adapter 6508, and a loading unit 6514. Theadapter 6508 releasably couples to the handle 6504 and the loading unit6514 releasably couples to the adapter 6508 such that the adapter 6508transmits a force from a drive shaft to the loading unit 6514. Theadapter 6508 or the loading unit 6514 may include a force gauge (notexplicitly shown) disposed therein to measure a force exerted on theloading unit 6514. The loading unit 6514 includes an end effector 6530having a first jaw 6532 and a second jaw 6534. The loading unit 6514 maybe an in-situ loaded or multi-firing loading unit (MFLU) that allows aclinician to fire a plurality of fasteners multiple times withoutrequiring the loading unit 6514 to be removed from a surgical site toreload the loading unit 6514.

The first and second jaws 6532, 6534 are configured to clamp tissuetherebetween, fire fasteners through the clamped tissue, and sever theclamped tissue. The first jaw 6532 may be configured to fire at leastone fastener a plurality of times, or may be configured to include areplaceable multi-fire fastener cartridge including a plurality offasteners (e.g., staples, clips, etc.) that may be fired more that onetime prior to being replaced. The second jaw 6534 may include an anvilthat deforms or otherwise secures the fasteners about tissue as thefasteners are ejected from the multi-fire fastener cartridge.

The handle 6504 includes a motor that is coupled to the drive shaft toaffect rotation of the drive shaft. The handle 6504 includes a controlinterface to selectively activate the motor. The control interface mayinclude buttons, switches, levers, sliders, touchscreen, and any othersuitable input mechanisms or user interfaces, which can be engaged by aclinician to activate the motor.

The control interface of the handle 6504 is in communication with acontroller 6528 of the handle 6504 to selectively activate the motor toaffect rotation of the drive shafts. The controller 6528 is disposedwithin the handle 6504 and is configured to receive input from thecontrol interface and adapter data from the adapter 6508 or loading unitdata from the loading unit 6514. The controller 6528 analyzes the inputfrom the control interface and the data received from the adapter 6508and/or loading unit 6514 to selectively activate the motor. The handle6504 may also include a display that is viewable by a clinician duringuse of the handle 6504. The display is configured to display portions ofthe adapter or loading unit data before, during, or after firing of theinstrument 6502.

The adapter 6508 includes an adapter identification device 6510 disposedtherein and the loading unit 6514 includes a loading unit identificationdevice 6516 disposed therein. The adapter identification device 6510 isin communication with the controller 6528, and the loading unitidentification device 6516 is in communication with the controller 6528.It will be appreciated that the loading unit identification device 6516may be in communication with the adapter identification device 6510,which relays or passes communication from the loading unitidentification device 6516 to the controller 6528.

The adapter 6508 may also include a plurality of sensors 6512 (oneshown) disposed thereabout to detect various conditions of the adapter6508 or of the environment (e.g., if the adapter 6508 is connected to aloading unit, if the adapter 6508 is connected to a handle, if the driveshafts are rotating, the torque of the drive shafts, the strain of thedrive shafts, the temperature within the adapter 6508, a number offirings of the adapter 6508, a peak force of the adapter 6508 duringfiring, a total amount of force applied to the adapter 6508, a peakretraction force of the adapter 6508, a number of pauses of the adapter6508 during firing, etc.). The plurality of sensors 6512 provides aninput to the adapter identification device 6510 in the form of datasignals. The data signals of the plurality of sensors 6512 may be storedwithin, or be used to update the adapter data stored within, the adapteridentification device 6510. The data signals of the plurality of sensors6512 may be analog or digital. The plurality of sensors 6512 may includea force gauge to measure a force exerted on the loading unit 6514 duringfiring.

The handle 6504 and the adapter 6508 are configured to interconnect theadapter identification device 6510 and the loading unit identificationdevice 6516 with the controller 6528 via an electrical interface. Theelectrical interface may be a direct electrical interface (i.e., includeelectrical contacts that engage one another to transmit energy andsignals therebetween). Additionally or alternatively, the electricalinterface may be a non-contact electrical interface to wirelesslytransmit energy and signals therebetween (e.g., inductively transfer).It is also contemplated that the adapter identification device 6510 andthe controller 6528 may be in wireless communication with one anothervia a wireless connection separate from the electrical interface.

The handle 6504 includes a transmitter 6506 that is configured totransmit instrument data from the controller 6528 to other components ofthe system 6500 (e.g., the LAN 6518, the cloud 6520, the console 6522,or the portable device 6526). The transmitter 6506 also may receive data(e.g., cartridge data, loading unit data, or adapter data) from theother components of the system 6500. For example, the controller 6528may transmit instrument data including a serial number of an attachedadapter (e.g., adapter 6508) attached to the handle 6504, a serialnumber of a loading unit (e.g., loading unit 6514) attached to theadapter, and a serial number of a multi-fire fastener cartridge (e.g.,multi-fire fastener cartridge), loaded into the loading unit, to theconsole 6528. Thereafter, the console 6522 may transmit data (e.g.,cartridge data, loading unit data, or adapter data) associated with theattached cartridge, loading unit, and adapter, respectively, back to thecontroller 6528. The controller 6528 can display messages on the localinstrument display or transmit the message, via transmitter 6506, to theconsole 6522 or the portable device 6526 to display the message on thedisplay 6524 or portable device screen, respectively.

Multi-Functional Surgical Control System and Switching Interface forVerbal Control of Imaging Device

FIG. 135 illustrates a verbal AESOP camera positioning system. Furtherexamples are disclosed in U.S. Pat. No. 7,097,640, entitledMULTI-FUNCTIONAL SURGICAL CONTROL SYSTEM AND SWITCHING INTERFACE, whichissued on Aug. 29, 2006, which is herein incorporated by reference inits entirety. FIG. 135 shows a surgical system 6550 that may be coupledto surgical hub 206, described in connection with FIGS. 1-11 . Thesystem 6550 allows a surgeon to operate a number of different surgicaldevices 6552, 6554, 6556, and 6558 from a single input device 6560.Providing a single input device reduces the complexity of operating thevarious devices and improves the efficiency of a surgical procedureperformed by a surgeon. The system 6550 may be adapted and configured tooperate a positioning system for an imaging device such as a camera orendoscope using verbal commands.

The surgical device 6552 may be a robotic arm which can hold and move asurgical instrument. The arm 6552 may be a device such as that sold byComputer Motion, Inc. of Goleta, Calif. under the trademark AESOP, whichis an acronym for Automated Endoscopic System for Optimal Positioning.The arm 6552 is commonly used to hold and move an endoscope within apatient. The system 6550 allows the surgeon to control the operation ofthe robotic arm 6552 through the input device 6560.

The surgical device 6554 may be an electrocautery device. Electrocauterydevices typically have a bi-polar tip which carries a current that heatsand denatures tissue. The device is typically coupled to an on-offswitch to actuate the device and heat the tissue. The electrocauterydevice may also receive control signals to vary its power output. Thesystem 6550 allows the surgeon to control the operation of theelectrocautery device through the input device 6560.

The surgical device 6556 may be a laser. The laser 6556 may be actuatedthrough an on-off switch. Additionally, the power of the laser 6556 maybe controlled by control signals. The system 6550 allows the surgeon tocontrol the operation of the laser 6556 through the input device 6560.

The device 6558 may be an operating table. The operating table 6558 maycontain motors and mechanisms which adjust the position of the table.The present invention allows the surgeon to control the position of thetable 6558 through the input device 6560. Although four surgical devices6552, 6554, 6556, and 6558 are described, it is to be understood thatother functions within the operating room may be controlled through theinput device 6560. By way of example, the system 6560 may allow thesurgeon to control the lighting and temperature of the operating roomthrough the input device 6560.

The input device 6560 may be a foot pedal which has a plurality ofbuttons 6562, 6564, 6565, 6566, and 6568 that can be depressed by thesurgeon. Each button is typically associated with a specific controlcommand of a surgical device. For example, when the input device 6560 iscontrolling the robotic arm 6552, depressing the button 6562 may movethe arm in one direction and depressing the button 6566 may move the armin an opposite direction. Likewise, when the electrocautery device 6554or the laser 6556 is coupled to the input device 6560, depressing thebutton 6568 may energize the devices, and so forth and so on. Although afoot pedal is shown and described, it is to be understood that the inputdevice 6560 may be a hand controller, a speech interface which acceptsvoice commands from the surgeon, a cantilever pedal or other inputdevices which may be well known in the art of surgical device control.Using the speech interface, the surgeon is able to position a camera orendoscope connected to the robotic arm 6552 using verbal commands. Theimaging device, such as a camera or endoscope, may be coupled to therobotic arm 6552 positioning system that be controlled through thesystem 6550 using verbal commands.

The system 6550 has a switching interface 6570 which couples the inputdevice 6560 to the surgical devices 6552, 6554, 6556, and 6558. Theinterface 6570 has an input channel 6572 which is connected to the inputdevice 6560 by a bus 6574. The interface 6570 also has a plurality ofoutput channels 6576, 6578, 6580, and 6582 that are coupled to thesurgical devices by busses 6584, 6586, 6588, 6590, 6624, 6626, 6628 andwhich may have adapters or controllers disposed in electricalcommunication therewith and therebetween. Such adapters and controllerswill be discussed in more detail hereinbelow.

Because each device 6552, 6554, 6556, 6558 may require specificallyconfigured control signals for proper operation, adapters 6620, 6622 ora controller 6618 may be placed intermediate and in electricalcommunication with a specific output channel and a specific surgicaldevice. In the case of the robotic arm system 6552, no adapter isnecessary and as such, the robotic arm system 6552 may be in directconnection with a specific output channel. The interface 6570 couplesthe input channel 6572 to one of the output channels 6576, 6578, 6580,and 6582.

The interface 6570 has a select channel 6592 which can switch the inputchannel 6572 to a different output channel 6576, 6578, 6580, or 6582 sothat the input device 6560 can control any of the surgical devices. Theinterface 6570 may be a multiplexor circuit constructed as an integratedcircuit and placed on an ASIC. Alternatively, the interface 6570 may bea plurality of solenoid actuated relays coupled to the select channel bya logic circuit. The interface 6570 switches to a specific outputchannel in response to an input signal or switching signal applied onthe select channel 6592.

As depicted in FIG. 135 , there may be several inputs to the selectchannel 6592. Such inputs originate from the foot pedal 6560, the speechinterface 6600 and the CPU 6662. The interface 6570 may have amultiplexing unit such that only one switching signal may be received atthe select channel 6592 at any one time, thus ensuring no substantialhardware conflicts. The prioritization of the input devices may beconfigured so the foot pedal has highest priority followed by the voiceinterface and the CPU. This is intended for example as theprioritization scheme may be employed to ensure the most efficientsystem. As such other prioritization schemes may be employed. The selectchannel 6592 may sequentially connect the input channel to one of theoutput channels each time a switching signal is provided to the selectchannel 6592. Alternatively, the select channel 6592 may be addressableso that the interface 6570 connects the input channel to a specificoutput channel when an address is provided to the select channel 6592.Such addressing is known in the art of electrical switches.

The select channel 6592 may be connected by line 6594 to a dedicatedbutton 6596 on the foot pedal 6560. The surgeon can switch surgicaldevices by depressing the button 6596. Alternatively, the select channel6592 may be coupled by line 6598 to a speech interface 6600 which allowsthe surgeon to switch surgical devices with voice commands.

The system 6550 may have a central processing unit (CPU) 6602 whichreceives input signals from the input device 6560 through the interface6570 and a bus 6585. The CPU 6602 receives the input signals, and canensure that no improper commands are being input at the controller. Ifthis occurs, the CPU 6602 may respond accordingly, either by sending adifferent switching signal to select channel 6592, or by alerting thesurgeon via a video monitor or speaker.

The CPU 6602 can also provide output commands for the select channel6592 on the bus 6608 and receives input commands from the speechinterface 6600 on the same bi-directional bus 6608. The CPU 6602 may becoupled to a monitor 6610 and/or a speaker 6612 by buses 6614 and 6616,respectively. The monitor 6610 may provide a visual indication of whichsurgical device is coupled to the input device 6560. The monitor mayalso provide a menu of commands which can be selected by the surgeoneither through the speech interface 6600 or button 6596. Alternatively,the surgeon could switch to a surgical device by selecting a commandthrough a graphic user interface. The monitor 6610 may also provideinformation regarding improper control signals sent to a specificsurgical device 6552, 6554, 6556, 6558 and recognized by the CPU 6602.Each device 6552, 6554, 6556, 6558 has a specific appropriate operatingrange, which is well known to the skilled artisan. As such, the CPU 6602may be programmed to recognize when the requested operation from theinput device 6560 is inappropriate and will then alert the surgeoneither visually via the monitor 6610 or audibly via the speaker 6612.The speaker 6612 may also provide an audio indication of which surgicaldevice is coupled to the input device 6560.

The system 6550 may include a controller 6618 which receives the inputsignals from the input device 6560 and provides corresponding outputsignals to control the operating table 6558. Likewise, the system mayhave adapters 6620, 6622 which provide an interface between the inputdevice 6560 and the specific surgical instruments connected to thesystem.

In operation, the interface 6570 initially couples the input device 6560to one of the surgical devices. The surgeon can control a differentsurgical device by generating an input command that is provided to theselect channel 6592. The input command switches the interface 6570 sothat the input device 6560 is coupled to a different output channel andcorresponding surgical device or adapter. What is thus provided is aninterface 6570 that allows a surgeon to select, operate and control aplurality of different surgical devices through a common input device6560.

FIG. 136 illustrates a multi-functional surgical control system 6650 andswitching interface for virtual operating room integration. A virtualcontrol system for controlling surgical equipment in an operating roomwhile a surgeon performs a surgical procedure on a patient, comprising:a virtual control device including an image of a control device locatedon a surface and a sensor for interrogating contact interaction of anobject with the image on the surface, the virtual control devicedelivering an interaction signal indicative of the contact interactionof the object with the image; and a system controller connected toreceive the interaction signal from the virtual control device and todeliver a control signal to the surgical equipment in response to theinteraction signal to control the surgical equipment in response to thecontact interaction of the object with the image. Further examples aredisclosed in U.S. Pat. No. 7,317,955, entitled VIRTUAL OPERATING ROOMINTEGRATION, which issued on Jan. 8, 2008, which is herein incorporatedby reference in its entirety.

As shown in FIG. 136 , communication links 6674 are established betweenthe system controller 6676 and the various components and functions ofthe virtual control system 6650. The communication links 6674 arepreferably optical paths, but the communication links may also be formedby radio frequency transmission and reception paths, hardwiredelectrical connections, or combinations of optical, radio frequency andhardwired connection paths as may be appropriate for the type ofcomponents and functions obtained by those components. The arrows at theends of the links 6674 represent the direction of primary informationflow.

The communication links 6674 with the surgical equipment 6652, a virtualcontrol panel 6556, a virtual foot switch 6654 and patient monitoringequipment 6660 are bidirectional, meaning that the information flows inboth directions through the links 6674 connecting those components andfunctions. For example, the system controller 6676 supplies signalswhich are used to create a control panel image from the virtual controlpanel 6656 and a foot switch image from the virtual foot switch 6654.The virtual control panel 6656 and the virtual foot switch 6654 supplyinformation to the system controller 6676 describing the physicalinteraction of the surgeon's finger and foot relative to a projectedcontrol panel image and the projected foot switch image. The systemcontroller 6676 responds to the information describing the physicalinteraction with the projected image, and supplies control signals tothe surgical equipment 6652 and patient monitoring equipment 6660 tocontrol functionality of those components in response to the physicalinteraction information. The control, status and functionalityinformation describing the surgical equipment 6652 and patientmonitoring equipment 6660 flows to the system controller 6676, and afterthat information is interpreted by the system controller 6676, it isdelivered to a system display 6670, a monitor 6666, and/or a heads updisplay 6668 for presentation.

The communication links 6674 between the system controller 6676 and thesystem display 6670, the heads up display 6668, the monitor 6666, a tagprinter 6658 and output devices 6664 are all uni-directional, meaningthat the information flows from the system controller 6676 to thosecomponents and functions. In a similar manner, the communication links6674 between the system controller 6676 and a scanner 6672 and the inputdevices 6662 are also unidirectional, but the information flows from thecomponents 6662, 6672 to the system controller 6676. In certaincircumstances, certain control and status information may flow betweenthe system controller 6676 and the components 6658, 6660, 6662, 6664,6666, 6668, 6670, 6672 in order to control the functionality of thethose components.

Each communication link 6674 preferably has a unique identity so thatthe system controller 6676 can individually communicate with each of thecomponents of the virtual control system 6650. The unique identity ofeach communication link is preferable when some or all of thecommunication links 6674 are through the same medium, as would be thecase of optical and radio frequency communications. The unique identityof each communication link 6674 assures that the system controller 6676has the ability to exercise individual control over each of thecomponents and functions on a very rapid and almost simultaneous manner.The unique identity of each communication link 6674 can be achieved byusing different frequencies for each communication link 6674 or by usingunique address and identification codes associated with thecommunications transferred over each communication link 6674.

In one aspect, the present disclosure provides illustrates a surgicalcommunication and control headset that interfaces with the surgical hub206 described in connection with FIGS. 1-11 . Further examples aredisclosed in U.S. Patent Application Publication No. 2009/0046146,entitled SURGICAL COMMUNICATION AND CONTROL SYSTEM, which published onFeb. 19, 2009, which is herein incorporated by reference in itsentirety. FIG. 137 illustrates a diagram 6680 of a beam source andcombined beam detector system utilized as a device control mechanism inan operating theater. The system 6680 is configured and wired to allowfor device control with the overlay generated on the primary proceduraldisplay. The footswitch shows a method to allow the user to click oncommand icons that would appear on the screen while the beam source isused to aim at the particular desired command icon to be clicked. Thecontrol system graphic user interface (GUI) and device control processorcommunicate and parameters are changed using the system. The system 6680includes a display 6684 coupled to a beam detecting sensor 6682 and ahead mounted source 6686. The beam detecting sensor 6682 is incommunication with a control system GUI overlay processor and beamsource processor 6688. The surgeon operates a footswitch 6692 or otheradjunctive switch, which provides a signal to a device control interfaceunit 6694.

The system 6680 will provide a means for a sterile clinician to controlprocedural devices in an easy and quick, yet hands free and centralizedfashion. The ability to maximize the efficiency of the operation andminimize the time a patient is under anesthesia is important to the bestpatient outcomes. It is common for surgeons, cardiologists orradiologists to verbally request adjustments be made to certain medicaldevices and electronic equipment used in the procedure outside thesterile field. It is typical that he or she must rely on another staffmember to make the adjustments he or she needs to settings on devicessuch as cameras, bovies, surgical beds, shavers, insufflators,injectors, to name a few. In many circumstances, having to command astaff member to make a change to a setting can slow down a procedurebecause the non-sterile staff member is busy with another task. Thesterile physician cannot adjust non-sterile equipment withoutcompromising sterility, so he or she must often wait for the non-sterilestaff member to make the requested adjustment to a certain device beforeresuming the procedure.

The system 6680 allows a user to use a beam source and beam detector toregenerate a pointer overlay coupled with a GUI and a concurrentswitching method (i.e., a foot switch, etc.) to allow the clinician toclick through commands on the primary display. In one aspect, a GUIcould appear on the procedural video display when activated, such aswhen the user tilts his or her head twice to awaken it or steps on afoot switch provided with the system. Or it is possible that a righthead tilt wakes up the system, and a left head tilt simply activates thebeam source. When the overlay (called device control GUI overlay)appears on the screen it shows button icons representing varioussurgical devices and the user can use the beam source, in this case alaser beam, to aim at the button icons. Once the laser is over theproper button icon, a foot switch, or other simultaneous switch methodcan be activated, effectively acting like a mouse click on a computer.For example a user can “wake up” the system, causing a the devicecontrol GUI overlay to pop up that lists button icons on the screen,each one labeled as a corresponding procedural medical device. The usercan point the laser at the correct box or device and click a foot pedal(or some other concurrent control—like voice control, waistband button,etc.) to make a selection, much like clicking a mouse on a computer. Thesterile physician can then select “insufflator, for example” Thesubsequent screen shows arrow icons that can be clicked for varioussettings for the device that need to be adjusted (pressure, rate, etc.).In one iteration, the user can then can point the laser at the up arrowand click the foot pedal repeatedly until the desired setting isattained.

In one aspect, components of the system 6680 could be coupled withexisting robotic endoscope holders to “steer” a rigid surgicalendoscopic camera by sending movement commands to the robotic endoscopeholding arm (provided separately, i.e., AESOP by Computer Motion). Theendoscope is normally held by an assistant nurse or resident physician.There are robotic and mechanical scope holders currently on the marketand some have even had been introduced with voice control. However,voice control systems have often proven cumbersome, slow and inaccurate.This aspect would employ a series of software and hardware components toallow the overlay to appear as a crosshair on the primary proceduralvideo screen. The user could point the beam source at any part of thequadrant and click a simultaneous switch, such as a foot pedal, to sendmovement commands to the existing robotic arm, which, when coupled withthe secondary trigger (i.e., a foot switch, waist band switch, etc.)would send a command to adjust the arm in minute increments in thedirection of the beam source. It could be directed by holding down thesecondary trigger until the desired camera angle and position isachieved and then released. This same concept could be employed forsurgical bed adjustments by having the overlay resemble the controls ofa surgical bed. The surgical bed is commonly adjusted during surgery toallow better access to the anatomy. Using the combination of the beamsource, in this case a laser, a beam detecting sensor such as a camera,a control system GUI overlay processing unit and beam source processor,and a device control interface unit, virtually any medical device couldbe controlled through this system. Control codes would be programmedinto the device control interface unit, and most devices can beconnected using an RS-232 interface, which is a standard for serialbinary data signals connecting between a DTE (Data Terminal Equipment)and a DCE (Data Circuit-terminating Equipment). The present inventionwhile described with reference to application in the medical field canbe expanded/modified for use in other fields. Another use of thisinvention could be in helping those who are without use of their handsdue to injury or handicap or for professions where the hands areoccupied and hands free interface is desired.

Surgical Hub with Direct Interface Control with Secondary SurgeonDisplay Units Designed to be within the Sterile Field and Accessible forInput and Display by the Surgeon

In one aspect, the surgical hub 206 provides a secondary user interfacethat enables display and control of surgical hub 206 functions from withthe sterile field. The secondary display could be used to change displaylocations, what information is displayed where, pass off control ofspecific functions or devices.

During a surgical procedure, the surgeon may not have a user interfacedevice accessible for interactive input by the surgeon and displaywithin the sterile field. Thus, the surgeon cannot interface with theuser interface device and the surgical hub from within the sterile fieldand cannot control other surgical devices through the surgical hub fromwithin the sterile field.

One solution provides a display unit designed to be used within thesterile field and accessible for input and display by the surgeon toallow the surgeon to have interactive input control from the sterilefield to control other surgical devices coupled to the surgical hub. Thedisplay unit is sterile and located within the sterile field to allowthe surgeons to interface with the display unit and the surgical hub todirectly interface and configure instruments as necessary withoutleaving the sterile field. The display unit is a master device and maybe used for display, control, interchanges of tool control, allowingfeeds from other surgical hubs without the surgeon leaving the sterilefield.

In one aspect, the present disclosure provides a control unit,comprising an interactive touchscreen display, an interface configuredto couple the interactive touchscreen display to a surgical hub, aprocessor, and a memory coupled to the processor. The memory storesinstructions executable by the processor to receive input commands fromthe interactive touchscreen display located inside a sterile field andtransmits the input commands to a surgical hub to control devicescoupled to the surgical hub located outside the sterile field.

In another aspect, the present disclosure provides a control unit,comprising an interactive touchscreen display, an interface configuredto couple the interactive touchscreen display to a surgical hub, and acontrol circuit configured to receive input commands from theinteractive touchscreen display located inside a sterile field andtransmit the input commands to a surgical hub to control devices coupledto the surgical hub located outside the sterile field.

In another aspect, the present disclosure provides a non-transitorycomputer readable medium storing computer readable instructions which,when executed, causes a machine to receive input commands from aninteractive touchscreen display located inside a sterile field andtransmit the input commands to a surgical hub through an interfaceconfigured to couple the interactive touchscreen display to the surgicalhub to control devices coupled to the surgical hub located outside thesterile field.

Providing a display unit designed to be used within the sterile fieldand accessible for input and display by the surgeon provides the surgeoninteractive input control from the sterile field to control othersurgical devices coupled to the surgical hub.

This display unit within the sterile field is sterile and allows thesurgeons to interface with it and the surgical hub. This gives thesurgeon control of the instruments coupled to the surgical hub andallows the surgeon to directly interface and configure the instrumentsas necessary without leaving the sterile field. The display unit is amaster device and may be used for display, control, interchanges of toolcontrol, allowing feeds from other surgical hubs without the surgeonleaving the sterile field.

In various aspects, the present disclosure provides a secondary userinterface to enable display and control of surgical hub functions fromwithin a sterile field. This control could be a display device like anI-pad, e.g., a portable interactive touchscreen display deviceconfigured to be introduced into the operating theater in a sterilemanner. It could be paired like any other device or it could be locationsensitive. The display device would be allowed to function in thismanner whenever the display device is placed over a specific location ofthe draped abdomen of the patient during a surgical procedure. In otheraspects, the present disclosure provides a smart retractor and a smartsticker. These and other aspects are described hereinbelow.

In one aspect, the present disclosure provides a secondary userinterface to enable display and control of surgical hub functions fromwithin the sterile field. In another aspect, the secondary display couldbe used to change display locations, determine what information andwhere the information is displayed, and pass off control of specificfunctions or devices.

There are four types of secondary surgeon displays in two categories.One type of secondary surgeon display units is designed to be usedwithin the sterile field and accessible for input and display by thesurgeon within the sterile field interactive control displays. Sterilefield interactive control displays may be shared or common sterile fieldinput control displays.

A sterile field display may be mounted on the operating table, on astand, or merely laying on the abdomen or chest of the patient. Thesterile field display is sterile and allows the surgeons to interfacewith the sterile field display and the surgical hub. This gives thesurgeon control of the system and allows them to directly interface andconfigure the sterile field display as necessary. The sterile fielddisplay may be configured as a master device and may be used fordisplay, control, interchanges of tool control, allowing feeds fromother surgical hubs, etc.

In one aspect, the sterile field display may be employed to re-configurethe wireless activation devices within the operating theater (OR) andtheir paired energy device if a surgeon hands the device to another.FIGS. 138A-138E illustrate various types of sterile field control anddata input consoles 6700, 6702, 6708, 6712, 6714 according to variousaspects of the present disclosure. Each of the disclosed sterile fieldcontrol and data input consoles 6700, 6702, 6708, 6712, 6714 comprise atleast one touchscreen 6701, 6704/6706, 6709, 6713, 6716 input/outputdevice layered on the top of an electronic visual display of aninformation processing system. The sterile field control and data inputconsoles 6700, 6702, 6708, 6712, 6714 may include batteries as a powersource. Some include a cable 6710 to connect to a separate power sourceor to recharge the batteries. A user can give input or control theinformation processing system through simple or multi-touch gestures bytouching the touchscreen 6701, 6704/6706, 6709, 6713, 6716 with astylus, one or more fingers, or a surgical tool. The sterile fieldcontrol and data input consoles 6700, 6702, 6708, 6712, 6714 may be usedto re-configure wireless activation devices within the operating theaterand a paired energy device if a surgeon hands the device to anothersurgeon. The sterile field control and data input consoles 6700, 6702,6708, 6712, 6714 may be used to accept consult feeds from anotheroperating theater where it would then configure a portion of theoperating theater screens or all of them to mirror the other operatingtheater so the surgeon is able to see what is needed to help. Thesterile field control and data input consoles 6700, 6702, 6708, 6712,6714 are configured to communicate with the surgical hub 206.Accordingly, the description of the surgical hub 206 discussed inconnection with FIGS. 1-11 is incorporated in this section by reference.

FIG. 138A illustrates a single zone sterile field control and data inputconsole 6700, according to one aspect of the present disclosure. Thesingle zone console 6700 is configured for use in a single zone within asterile field. Once deployed in a sterile field, the single zone console6700 can receive touchscreen inputs from a user in the sterile field.The touchscreen 6701 enables the user to interact directly with what isdisplayed, rather than using a mouse, touchpad, or other such devices(other than a stylus or surgical tool). The single zone console 6700includes wireless communication circuits to communicate wirelessly tothe surgical hub 206.

FIG. 138B illustrates a multi zone sterile field control and data inputconsole 6702, according to one aspect of the present disclosure. Themulti zone console 6702 comprises a first touchscreen 6704 to receive aninput from a first zone of a sterile field and a second touchscreen 6706to receive an input from a second zone of a sterile field. The multizone console 6702 is configured to receive inputs from multiple users ina sterile field. The multi zone console 6702 includes wirelesscommunication circuits to communicate wirelessly to the surgical hub206. Accordingly, the multi zone sterile field control and data inputconsole 6702 comprises an interactive touchscreen display with multipleinput and output zones.

FIG. 138C illustrates a tethered sterile field control and data inputconsole 6708, according to one aspect of the present disclosure. Thetethered console 6708 includes a cable 6710 to connect the tetheredconsole 6708 to the surgical hub 206 via a wired connection. The cable6710 enables the tethered console 6708 to communicate over a wired linkin addition to a wireless link. The cable 6710 also enables the tetheredconsole 6708 to connect to a power source for powering the console 6708and/or recharging the batteries in the console 6708.

FIG. 138D illustrates a battery operated sterile field control and datainput console 6712, according to one aspect of the present disclosure.The sterile field console 6712 is battery operated and includes wirelesscommunication circuits to communicate wirelessly with the surgical hub206. In particular, in one aspect, the sterile field console 6712 isconfigured to communicate with any of the modules coupled to the hub 206such as the generator module 240. Through the sterile field console6712, the surgeon can adjust the power output level of a generator usingthe touchscreen 6713 interface. One example is described below inconnection with FIG. 138E.

FIG. 138E illustrates a battery operated sterile field control and datainput console 6714, according to one aspect of the present disclosure.The sterile field console 6714 includes a user interface displayed onthe touchscreen of a generator. The surgeon can thus control the outputof the generator by touching the up/down arrow icons 6718A, 6718B thatincrease/decrease the power output of the generator module 240.Additional icons 6719 enable access to the generator module settings6174, volume 6178 using the +/− icons, among other features directlyfrom the sterile field console 6714. The sterile field console 6714 maybe employed to adjust the settings or reconfigure other wirelessactivations devices or modules coupled to the hub 206 within theoperating theater and their paired energy device when the surgeon handsthe sterile field console 6714 to another.

FIGS. 139A-139B illustrate a sterile field console 6700 in use in asterile field during a surgical procedure, according to one aspect ofthe present disclosure. FIG. 139A shows the sterile field console 6714positioned in the sterile field near two surgeons engaged in anoperation. In FIG. 139B, one of the surgeons is shown tapping thetouchscreen 6701 of the sterile field console with a surgical tool 6722to adjust the output of a modular device coupled to the surgical hub206, reconfigure the modular device, or an energy device paired with themodular device coupled to the surgical hub 206.

In another aspect, the sterile field display may be employed to acceptconsult feeds from another operating room (OR), such as anotheroperating theater or surgical hub 206, where it would then configure aportion of the OR screens or all of them to mirror the other ORs so thesurgeon could see what is needed to help. FIG. 140 illustrates a process6750 for accepting consult feeds from another operating room, accordingto one aspect of the present disclosure. The sterile field control anddata input consoles 6700, 6702, 6708, 6712, 6714 shown in FIGS.138A-138E, 139A-139B may be used as an interact-able scalable secondarydisplay allowing the surgeon to overlay other feeds or images from laserDoppler image scanning arrays or other image sources. The sterile fieldcontrol and data input consoles 6700, 6702, 6708, 6712, 6714 may be usedto call up a pre-operative scan or image to review. Laser Dopplertechniques are described in U.S. Provisional Patent Application Ser. No.62/611,341, filed Dec. 28, 2017, and entitled INTERACTIVE SURGICALPLATFORM, which is incorporated herein by reference in its entirety.

It is recognized that the tissue penetration depth of light is dependenton the wavelength of the light used. Thus, the wavelength of the lasersource light may be chosen to detect particle motion (such a bloodcells) at a specific range of tissue depth. A laser Doppler employsmeans for detecting moving particles such as blood cells based at avariety of tissue depths based on the laser light wavelength. A lasersource may be directed to a surface of a surgical site. A blood vessel(such as a vein or artery) may be disposed within the tissue at somedepth δ from the tissue surface. Red laser light (having a wavelength inthe range of about 635 nm to about 660 nm) may penetrate the tissue to adepth of about 1 mm. Green laser light (having a wavelength in the rangeof about 520 nm to about 532 nm) may penetrate the tissue to a depth ofabout 2-3 mm. Blue laser light (having a wavelength in the range ofabout 405 nm to about 445 nm) may penetrate the tissue to a depth ofabout 4 mm or greater. A blood vessel may be located at a depth of about2-3 mm below the tissue surface. Red laser light will not penetrate tothis depth and thus will not detect blood cells flowing within thisvessel. However, both green and blue laser light can penetrate thisdepth. Therefore, scattered green and blue laser light from the bloodcells will result in an observed Doppler shift in both the green andblue.

In some aspects, a tissue may be probed by red, green, and blue laserillumination in a sequential manner and the effect of such illuminationmay be detected by a CMOS imaging sensor over time. It may be recognizedthat sequential illumination of the tissue by laser illumination atdiffering wavelengths may permit a Doppler analysis at varying tissuedepths over time. Although red, green, and blue laser sources may beused to illuminate the surgical site, it may be recognized that otherwavelengths outside of visible light (such as in the infrared orultraviolet regions) may be used to illuminate the surgical site forDoppler analysis. The imaging sensor information may be provided to thesterile field control and data input consoles 6700, 6702, 6708, 6712,6714.

The sterile field control and data input consoles 6700, 6702, 6708,6712, 6714 provide access to past recorded data. In one operatingtheater designated as OR1, the sterile field control and data inputconsoles 6700, 6702, 6708, 6712, 6714 may be configured as “consultants”and to erase all data when the consultation is complete. In anotheroperating theater designated as OR3 (operating room 3), the sterilefield control and data input consoles 6700, 6702, 6708, 6712, 6714 maybe configured as a “consultees” and are configured to record all datareceived from operating theater OR1 (operating room 1) sterile fieldcontrol and data input consoles 6700, 6702, 6708, 6712, 6714. Theseconfigurations are summarized in TABLE 2 below:

TABLE 2 Sterile Field Control And Data Sterile Field Control And DataInput Console In OR1 Input Console In OR3 Access to past recorded dataOR1 Consultant OR 3 Consultee Erase data when done Record all data

In one implementation of the process 6750, operating theater OR1receives 6752 a consult request from OR3. Data is transferred to the OR1sterile field control and data input console 6700, for example. The datais temporarily stored 6754. The data is backed up in time and the OR1view 6756 of the temporary data begins on the OR1 sterile field controland data input console 6700 touchscreen 6701. When the view is complete,the data is erased 6758 and control returns 6760 to OR1. The data isthen erased 6762 from the OR1 sterile field control and data inputconsole 6700 memory.

In yet another aspect, the sterile field display may be employed as aninteractable scalable secondary display allowing the surgeon to overlayother feeds or images like laser Doppler scanning arrays. In yet anotheraspect, the sterile field display may be employed to call up apre-operative scan or image to review. Once vessel path and depth anddevice trajectory are estimated, the surgeon employs a sterile fieldinteractable scalable secondary display allowing the surgeon to overlayother feeds or images.

FIG. 141 is a diagram 6770 that illustrates a technique for estimatingvessel path, depth, and device trajectory. Prior to dissecting a vessel6772, 6774 located below the surface of the tissue 6775 using a standardapproach, the surgeon estimates the path and depth of the vessel 6772,6774 and a trajectory 6776 of a surgical device 6778 will take to reachthe vessel 6772, 6774. It is often difficult to estimate the path anddepth 6776 of a vessel 6772, 6774 located below the surface of thetissue 6775 because the surgeon cannot accurately visualize the locationof the vessel 6772, 6774 path and depth 6776.

FIGS. 142A-142D illustrate multiple real time views of images of avirtual anatomical detail for dissection including perspective views(FIGS. 142A, 142C) and side views (FIGS. 142B, 142D). The images aredisplayed on a sterile field display of tablet computer or sterile fieldcontrol and data input console employed as an interactable scalablesecondary display allowing the surgeon to overlay other feeds or images,according to one aspect of the present disclosure. The images of thevirtual anatomy enable the surgeon to more accurately predict the pathand depth of a vessel 6772, 6774 located below the surface of the tissue6775 as shown in FIG. 141 and the best trajectory 6776 of the surgicaldevice 6778.

FIG. 142A is a perspective view of a virtual anatomy 6780 displayed on atablet computer or sterile field control and data input console. FIG.142B is a side view of the virtual anatomy 6780 shown in FIG. 142A,according to one aspect of the present disclosure. With reference toFIGS. 142A-142B, in one aspect, the surgeon uses a smart surgical device6778 and a tablet computer to visualize the virtual anatomy 6780 in realtime and in multiple views. The three dimensional perspective viewincludes a portion of tissue 6775 in which the vessels 6772, 6774 arelocated below surface. The portion of tissue is overlaid with a grid6786 to enable the surgeon to visualize a scale and gauge the path anddepth of the vessels 6772, 6774 at target locations 6782, 6784 eachmarked by an X. The grid 6786 also assists the surgeon determine thebest trajectory 6776 of the surgical device 6778. As illustrated, thevessels 6772, 6774 have an unusual vessel path.

FIG. 142C illustrates a perspective view of the virtual anatomy 6780 fordissection, according to one aspect of the present disclosure. FIG. 142Dis a side view of the virtual anatomy 6780 for dissection, according toone aspect of the present disclosure. With reference to FIGS. 142C-142D,using the tablet computer, the surgeon can zoom and pan 360° to obtainan optimal view of the virtual anatomy 6780 for dissection. The surgeonthen determines the best path or trajectory 6776 to insert the surgicaldevice 6778 (e.g., a dissector in this example). The surgeon may viewthe anatomy in a three-dimensional perspective view or any one of sixviews. See for example the side view of the virtual anatomy in FIG. 142Dand the insertion of the surgical device 6778 (e.g., the dissector).

In another aspect, a sterile field control and data input console mayallow live chatting between different departments, such as, for example,with the oncology or pathology department, to discuss margins or otherparticulars associated with imaging. The sterile field control and datainput console may allow the pathology department to tell the surgeonabout relationships of the margins within a specimen and show them tothe surgeon in real time using the sterile field console.

In another aspect, a sterile field control and data input console may beused to change the focus and field of view of its own image or controlthat of any of the other monitors coupled to the surgical hub.

In another aspect, a sterile field control and data input console may beused to display the status of any of the equipment or modules coupled tothe surgical hub 206. Knowledge of which device coupled to the surgicalhub 206 is being used may be obtained via information such as the deviceis not on the instrument pad or on-device sensors. Based on thisinformation, the sterile field control and data input console may changedisplay, configurations, switch power to drive one device, and notanother, one cord from capital to instrument pad and multiple cords fromthere. Device diagnostics may obtain knowledge that the device isinactive or not being used. Device diagnostics may be based oninformation such as the device is not on the instrument pad or basedon-device sensors.

In another aspect, a sterile field control and data input console may beused as a learning tool. The console may display checklists, proceduresteps, and/or sequence of steps. A timer/clock may be displayed tomeasure time to complete steps and/or procedures. The console maydisplay room sound pressure level as indicator for activity, stress,etc.

FIGS. 143A-143B illustrate a touchscreen display 6890 that may be usedwithin the sterile field, according to one aspect of the presentdisclosure. Using the touchscreen display 6890, a surgeon can manipulateimages 6892 displayed on the touchscreen display 6890 using a variety ofgestures such as, for example, drag and drop, scroll, zoom, rotate, tap,double tap, flick, drag, swipe, pinch open, pinch close, touch and hold,two-finger scroll, among others.

FIG. 143A illustrates an image 6892 of a surgical site displayed on atouchscreen display 6890 in portrait mode. FIG. 143B shows thetouchscreen display 6890 rotated 6894 to landscape mode and the surgeonuses his index finger 6896 to scroll the image 6892 in the direction ofthe arrows. FIG. 143C shows the surgeon using his index finger 6896 andthumb 6898 to pinch open the image 6892 in the direction of the arrows6899 to zoom in. FIG. 143D shows the surgeon using his index finger 6896and thumb 6898 to pinch close the image 6892 in the direction of thearrows 6897 to zoom out. FIG. 143E shows the touchscreen display 6890rotated in two directions indicated by arrows 6894, 6896 to enable thesurgeon to view the image 6892 in different orientations.

Outside the sterile field, control and static displays are used that aredifferent from the control and static displays used inside the sterilefield. The control and static displays located outside the sterile fieldprovide interactive and static displays for operating theater (OR) anddevice control. The control and static displays located outside thesterile field may include secondary static displays and secondarytouchscreens for input and output.

Secondary static non-sterile displays 107, 109, 119 (FIG. 2 ) for usedoutside the sterile field include monitors placed on the wall of theoperating theater, on a rolling stand, or on capital equipment. A staticdisplay is presented with a feed from the control device to which theyare attached and merely displays what is presented to it.

Secondary touch input screens located outside the sterile field may bepart of the visualization system 108 (FIG. 2 ), part of the surgical hub108 (FIG. 2 ), or may be fixed placement touch monitors on the walls orrolling stands. One difference between secondary touch input screens andstatic displays is that a user can interact with a secondary touch inputscreen by changing what is displayed on that specific monitor or others.For capital equipment applications, it could be the interface to controlthe setting of the connected capital equipment. The secondary touchinput screens and the static displays outside the sterile field can beused to preload the surgeon's preferences (instrumentation settings andmodes, lighting, procedure and preferred steps and sequence, music,etc.)

Secondary surgeon displays may include personal input displays with apersonal input device that functions similarly to the common sterilefield input display device but it is controlled by a specific surgeon.Personal secondary displays may be implemented in many form factors suchas, for example, a watch, a small display pad, interface glasses, etc. Apersonal secondary display may include control capabilities of a commondisplay device and since it is located on or controlled by a specificsurgeon, the personal secondary display would be keyed to him/herspecifically and would indicate that to others and itself. Generallyspeaking, a personal secondary display would normally not be useful toexchanging paired devices because they are not accessible to more thanone surgeon. Nevertheless, a personal secondary display could be used togrant permission for release of a device.

A personal secondary display may be used to provide dedicated data toone of several surgical personnel that wants to monitor something thatthe others typically would not want to monitor. In addition, a personalsecondary display may be used as the command module. Further, a personalsecondary display may be held by the chief surgeon in the operatingtheater and would give the surgeon the control to override any of theother inputs from anyone else. A personal secondary display may becoupled to a short range wireless, e.g., Bluetooth, microphone andearpiece allowing the surgeon to have discrete conversations or calls orthe personal secondary display may be used to broadcast to all theothers in the operating theater or other department.

FIG. 144 illustrates a surgical site 6900 employing a smart surgicalretractor 6902 comprising a direct interface control to a surgical hub206 (FIGS. 1-11 ), according to one aspect of the present disclosure.The smart surgical retractor 6902 helps the surgeon and operating roomprofessionals hold an incision or wound open during surgical procedures.The smart surgical retractor 6902 aids in holding back underlying organsor tissues, allowing doctors/nurses better visibility and access to theexposed area. With reference also to FIGS. 1-11 , the smart surgicalretractor 6902 may comprise an input display 6904 operated by the smartsurgical retractor 6902. The smart surgical retractor 6902 may comprisea wireless communication device to communicate with a device connectedto a generator module 240 coupled to the surgical hub 206. Using theinput display 6904 of the smart surgical retractor 6902, the surgeon canadjust power level or mode of the generator module 240 to cut and/orcoagulate tissue. If using automatic on/off for energy delivery onclosure of an end effector on the tissue, the status of automatic on/offmay be indicated by a light, screen, or other device located on thesmart retractor 6902 housing. Power being used may be changed anddisplayed.

In one aspect, the smart surgical retractor 6902 can sense or know whatdevice/instrument 235 the surgeon is using, either through the surgicalhub 206 or RFID or other device placed on the device/instrument 235 orthe smart surgical retractor 6902, and provide an appropriate display.Alarm and alerts may be activated when conditions require. Otherfeatures include displaying the temperature of the ultrasonic blade,nerve monitoring, light source 6906 or fluorescence. The light source6906 may be employed to illuminate the surgical field of view 6908 andto charge photocells 6918 on single use sticker display that stick ontothe smart retractor 6902 (see FIG. 145 , for example). In anotheraspect, the smart surgical retractor 6902 may include an augmentedreality projected on the patient's anatomy (e.g., like a vein viewer).

FIG. 145 illustrates a surgical site 6910 with a smart flexible stickerdisplay 6912 attached to the body/skin 6914 of a patient, according toone aspect of the present disclosure. As shown, the smart flexiblesticker display 6912 is applied to the body/skin 6914 of a patientbetween the area exposed by the surgical retractors 6916. In one aspect,the smart flexible sticker display 6912 may be powered by light, an onboard battery, or a ground pad. The flexible sticker display 6912 maycommunicate via short range wireless (e.g., Bluetooth) to a device, mayprovide readouts, lock power, or change power. The smart flexiblesticker display 6912 also comprises photocells 6918 to power the smartflexible sticker display 6912 using ambient light energy. The flexiblesticker display 6912 includes a display of a control panel 6920 userinterface to enable the surgeon to control devices 235 or other modulescoupled to the surgical hub 206 (FIGS. 1-11 ).

FIG. 146 is a logic flow diagram 6920 of a process depicting a controlprogram or a logic configuration to communicate from inside a sterilefield to a device located outside the sterile field, according to oneaspect of the present disclosure. In one aspect, a control unitcomprises an interactive touchscreen display, an interface configured tocouple the interactive touchscreen display to a surgical hub, aprocessor, and a memory coupled to the processor. The memory storesinstructions executable by the processor to receive 6922 input commandsfrom the interactive touchscreen display located inside a sterile fieldand transmits 6924 the input commands to a surgical hub to controldevices coupled to the surgical hub located outside the sterile field.

FIG. 147 illustrates a system for performing surgery. The systemcomprises a control box which includes internal circuitry; a surgicalinstrument including a distal element and techniques for sensing aposition or condition of said distal element; techniques associated withsaid surgical instrument for transmitting said sensed position orcondition to said internal circuitry of said control box; and fortransmitting said sensed position or condition from said internalcircuitry of said control box to a video monitor for display thereon,wherein said sensed position or condition is displayed on said videomonitor as an icon or symbol, further comprising a voltage source forgenerating a voltage contained entirely within said surgical instrument.Further examples are disclosed in U.S. Pat. No. 5,503,320, entitledSURGICAL APPARATUS WITH INDICATOR, which issued on Apr. 2, 1996, whichis herein incorporated by reference in its entirety.

FIG. 147 shows schematically a system whereby data is transmitted to avideo monitor for display, such data relating to the position and/orcondition of one or more surgical instruments. As shown in FIG. 147 , alaparoscopic surgical procedure is being performed wherein a pluralityof trocar sleeves 6930 are inserted through a body wall 6931 to provideaccess to a body cavity 6932. A laparoscope 6933 is inserted through oneof the trocar sleeves 6930 to provide illumination (light cable 6934 isshown leading toward a light source, not pictured) to the surgical siteand to obtain an image thereof. A camera adapter 6935 is attached at theproximal end of laparoscope 6933 and image cable 6936 extends therefromto a control box 6937 discussed in more detail below. Image cable inputsto image receiving port 416 on control box 6937.

Additional surgical instruments 6939, 6940 are inserted throughadditional trocar sleeves 6900 which extend through body wall 6931. InFIG. 147 , instrument 6939 schematically illustrates an endoscopicstapling device, e.g., an Endo GIA* instrument manufactured by theassignee of this application, and instrument 6940 schematicallyillustrates a hand instrument, e.g., an Endo Grasp* device alsomanufactured by the present assignee. Additional and/or alternativeinstruments may also be utilized according to the present invention; theillustrated instruments are merely exemplary of surgical instrumentswhich may be utilized according to the present invention.

Instruments 6939, 6940 include adapters 6941, 6942 associated with theirrespective handle portions. The adapters electronically communicate withconductive mechanisms (not pictured). These mechanisms, which includeelectrically conductive contact members electrically connected by wires,cables and the like, are associated with the distal elements of therespective instruments, e.g., the anvil 6943 and cartridge 6944 of theEndo GIA* instrument, the jaws 6945, 6946 of the Endo Grasp* device, andthe like. The mechanisms are adapted to interrupt an electronic circuitwhen the distal elements are in a first position or condition and tocomplete the electronic circuit when the distal elements are in a secondposition or condition. A voltage source for the electronic circuit maybe provided in the surgical instrument, e.g., in the form of a battery,or supplied from control box 6937 through cables 6947, 6948.

Control box 6937 includes a plurality of jacks 6949 which are adapted toreceive cables 6947, 6948 and the like. Control box 6937 furtherincludes an outgoing adapter 6950 which is adapted to cooperate with acable 6951 for transmitting the laparoscopic image obtained by thelaparoscope 6933 together with data concerning surgical instruments6939, 6940 to video monitor 6952. Circuitry within control box 6937 isprovided for converting the presence of an interrupted circuit, e.g.,for the electronics within cable 6947 and the mechanism associated withthe distal elements of instrument 6939, to an icon or symbol for displayon video monitor 6952. Similarly, the circuitry within control box 6937is adapted to provide a second icon or symbol to video monitor 6952 whena completed circuit exists for cable 6947 and the associated mechanism.

Illustrative icons/symbols 6953, 6954 are shown on video monitor 6952.Icon 6953 shows a surgical staple and could be used to communicate tothe surgeon that the cartridge 6944 and anvil 6943 of instrument 6939are properly positioned to form staples in tissue 6955. Icon 6953 couldtake another form when the cartridge 6944 and anvil 6943 are notproperly positioned for forming staples, thereby interrupting thecircuit. Icon 6954 shows a hand instrument with jaws spread apart,thereby communicating to the surgeon that the jaws 6945, 6946 ofinstrument 6940 are open. Icon 6954 could take another form when jaws6945, 6946 are closed, thereby completing the circuit.

FIG. 148 illustrates a second layer of information overlaying a firstlayer of information. The second layer of information includes asymbolic representation of the knife overlapping the detected positionof the knife in the DLU depicted in the first layer of information.Further examples are disclosed in U.S. Pat. No. 9,283,054, entitledSURGICAL APPARATUS WITH INDICATOR, which issued on Mar. 15, 2016, whichis herein incorporated by reference in its entirety.

Referring to FIG. 148 , the second layer of information 6963 can overlayat least a portion of the first layer of information 6962 on the display6960. Furthermore, the touch screen 6961 can allow a user to manipulatethe second layer of information 6963 relative to the video feedback inthe underlying first layer of information 6962 on the display 6960. Forexample, a user can operate the touch screen 6961 to select, manipulate,reformat, resize, and/or otherwise modify the information displayed inthe second layer of information 6963. In certain aspects, the user canuse the touch screen 6961 to manipulate the second layer of information6963 relative to the surgical instrument 6964 depicted in the firstlayer of information 6962 on the display 6960. A user can select a menu,category and/or classification of the control panel 6967 thereof, forexample, and the second layer of information 6963 and/or the controlpanel 6967 can be adjusted to reflect the user's selection. In variousaspects, a user may select a category from the instrument feedbackcategory 6969 that corresponds to a specific feature or features of thesurgical instrument 6964 depicted in the first layer of information6962. Feedback corresponding to the user-selected category can move,locate itself, and/or “snap” to a position on the display 6960 relativeto the specific feature or features of the surgical instrument 6964. Forexample, the selected feedback can move to a position near and/oroverlapping the specific feature or features of the surgical instrument6964 depicted in the first layer of information 6962.

The instrument feedback menu 6969 can include a plurality of feedbackcategories, and can relate to the feedback data measured and/or detectedby the surgical instrument 6964 during a surgical procedure. Asdescribed herein, the surgical instrument 6964 can detect and/or measurethe position 6970 of a moveable jaw between an open orientation and aclosed orientation, the thickness 6973 of clamped tissue, the clampingforce 6976 on the clamped tissue, the articulation 6974 of the DLU 6965,and/or the position 6971, velocity 6972, and/or force 6975 of the firingelement, for example. Furthermore, the feedback controller in signalcommunication with the surgical instrument 6964 can provide the sensedfeedback to the display 6960, which can display the feedback in thesecond layer of information 6963. As described herein, the selection,placement, and/or form of the feedback data displayed in the secondlayer of information 6963 can be modified based on the user's input tothe touch screen 6961, for example.

When the knife of the DLU 6965 is blocked from view by the end effectorjaws 6966 and/or tissue T, for example, the operator can track and/orapproximate the position of the knife in the DLU 6964 based on thechanging value of the feedback data and/or the shifting position of thefeedback data relative to the DLU 6965 depicted in the underlying firstlayer of information 6962.

In various aspects, the display menu 6977 of the control panel 6967 canrelate to a plurality of categories, such as unit systems 6978 and/ordata modes 6979, for example. In certain aspects, a user can select theunit systems category 6978 to switch between unit systems, such asbetween metric and U.S. customary units, for example. Additionally, auser can select the data mode category 6979 to switch between types ofnumerical representations of the feedback data and/or types of graphicalrepresentations of the feedback data, for example. The numericalrepresentations of the feedback data can be displayed as numericalvalues and/or percentages, for example. Furthermore, the graphicalrepresentations of the feedback data can be displayed as a function oftime and/or distance, for example. As described herein, a user canselect the instrument controller menu 6980 from the control panel 6967to input directives for the surgical instrument 6964, which can beimplemented via the instrument controller and/or the microcontroller,for example. A user can minimize or collapse the control panel 6967 byselecting the minimize/maximize icon 6968, and can maximize orun-collapse the control panel 6967 by re-selecting the minimize/maximizeicon 6968.

FIG. 149 depicts a perspective view of a surgeon using a surgicalinstrument that includes a handle assembly housing and a wirelesscircuit board during a surgical procedure, with the surgeon wearing aset of safety glasses. The wireless circuit board transmits a signal toa set of safety glasses worn by a surgeon using the surgical instrumentduring a procedure. The signal is received by a wireless port on thesafety glasses. One or more lighting devices on a front lens of thesafety glasses change color, fade, or glow in response to the receivedsignal to indicate information to the surgeon about the status of thesurgical instrument. The lighting devices are disposable on peripheraledges of the front lens to not distract the direct line of vision of thesurgeon. Further examples are disclosed in U.S. Pat. No. 9,011,427,entitled SURGICAL INSTRUMENT WITH SAFETY GLASSES, which issued on Apr.21, 2015, which is herein incorporated by reference in its entirety.

FIG. 149 shows a version of safety glasses 6991 that may be worn by asurgeon 6992 during a surgical procedure while using a medical device.In use, a wireless communications board housed in a surgical instrument6993 may communicate with a wireless port 6994 on safety glasses 6991.Exemplary surgical instrument 6993 is a battery-operated device, thoughinstrument 6993 could be powered by a cable or otherwise. Instrument6993 includes an end effector. Particularly, wireless communicationsboard 6995 transmits one or more wireless signals indicated by arrows(B, C) to wireless port 6994 of safety glasses 6991. Safety glasses 6991receive the signal, analyze the received signal, and display indicatedstatus information received by the signal on lenses 6996 to a user, suchas surgeon 6992, wearing safety glasses 6991. Additionally oralternatively, wireless communications board 6995 transmits a wirelesssignal to surgical monitor 6997 such that surgical monitor 6997 maydisplay received indicated status information to surgeon 6992, asdescribed above.

A version of the safety glasses 6991 may include lighting device onperipheral edges of the safety glasses 6991. A lighting device providesperipheral-vision sensory feedback of instrument 6993, with which thesafety glasses 6991 communicate to a user wearing the safety glasses6991. The lighting device may be, for example, a light-emitted diode(“LED”), a series of LEDs, or any other suitable lighting device knownto those of ordinary skill in the art and apparent in view of theteachings herein.

LEDs may be located at edges or sides of a front lens of the safetyglasses 6991 so not to distract from a user's center of vision whilestill being positioned within the user's field of view such that theuser does not need to look away from the surgical site to see thelighting device. Displayed lights may pulse and/or change color tocommunicate to the wearer of the safety glasses 6991 various aspects ofinformation retrieved from instrument 6993, such as system statusinformation or tissue sensing information (i.e., whether the endeffector has sufficiently severed and sealed tissue). Feedback fromhoused wireless communications board 6995 may cause a lighting device toactivate, blink, or change color to indicate information about the useof instrument 6993 to a user. For example, a device may incorporate afeedback mechanism based on one or more sensed tissue parameters. Inthis case, a change in the device output(s) based on this feedback insynch with a tone change may submit a signal through wirelesscommunications board 6995 to the safety glasses 6991 to triggeractivation of the lighting device. Such described means of activation ofthe lighting device should not be considered limiting as other means ofindicating status information of instrument 6993 to the user via thesafety glasses 6991 are contemplated. Further, the safety glasses 6991may be single-use or reusable eyewear. Button-cell power supplies suchas button-cell batteries may be used to power wireless receivers andLEDs of versions of safety glasses 6991, which may also include a housedwireless board and tri-color LEDs. Such button-cell power supplies mayprovide a low-cost means of providing sensory feedback of informationabout instrument 6993 when in use to surgeon 6992 wearing safety glasses6991.

FIG. 150 is a schematic diagram of a feedback control system forcontrolling a surgical instrument. The surgical instrument includes ahousing and an elongated shaft that extends distally from the housingand defines a first longitudinal axis. The surgical instrument alsoincludes a firing rod disposed in the elongated shaft and a drivemechanism disposed at least partially within the housing. The drivemechanism mechanically cooperates with the firing rod to move the firingrod. A motion sensor senses a change in the electric field (e.g.,capacitance, impedance, or admittance) between the firing rod and theelongated shaft. The measurement unit determines a parameter of themotion of the firing rod, such as the position, speed, and direction ofthe firing rod, based on the sensed change in the electric field. Acontroller uses the measured parameter of the motion of the firing rodto control the drive mechanism. Further examples are disclosed in U.S.Pat. No. 8,960,520, entitled METHOD AND APPARATUS FOR DETERMININGPARAMETERS OF LINEAR MOTION IN A SURGICAL INSTRUMENT, which issued onFeb. 24, 2015, which is herein incorporated by reference in itsentirety.

With reference to FIG. 150 , aspects of the present disclosure mayinclude a feedback control system 6150. The system 6150 includes afeedback controller 6152. The surgical instrument 6154 is connected tothe feedback controller 6152 via a data port, which may be either wired(e.g., FireWire®, USB, Serial RS232, Serial RS485, USART, Ethernet,etc.) or wireless (e.g., Bluetooth®, ANT3®, KNX®, Z-Wave X10®, WirelessUSB®, Wi-Fi®, IrDA®, nanoNET®, TinyOS®, ZigBee®, 802.11 IEEE, and otherradio, infrared, UHF, VHF communications and the like). The feedbackcontroller 6152 is configured to store the data transmitted to it by thesurgical instrument 6154 as well as process and analyze the data. Thefeedback controller 6152 is also connected to other devices, such as avideo display 6154, a video processor 6156 and a computing device 6158(e.g., a personal computer, a PDA, a smartphone, a storage device,etc.). The video processor 6156 is used for processing output datagenerated by the feedback controller 6152 for output on the videodisplay 6154. The computing device 6158 is used for additionalprocessing of the feedback data. In one aspect, the results of thesensor feedback analysis performed by a microcontroller may be storedinternally for later retrieval by the computing device 6158.

FIG. 151 illustrates a feedback controller 6152 including an on-screendisplay (OSD) module and a heads-up-display (HUD) module. The modulesprocess the output of a microcontroller for display on various displays.More specifically, the OSD module overlays text and/or graphicalinformation from the feedback controller 6152 over other video imagesreceived from the surgical site via cameras disposed therein. Themodified video signal having overlaid text is transmitted to the videodisplay allowing the user to visualize useful feedback information fromthe surgical instrument 6154 and/or feedback controller 6152 while stillobserving the surgical site. The feedback controller 6152 includes adata port 6160 coupled to a microcontroller which allows the feedbackcontroller 6152 to be connected to the computing device 6158 (FIG. 150). The data port 6160 may provide for wired and/or wirelesscommunication with the computing device 6158 providing for an interfacebetween the computing device 6158 and the feedback controller 6152 forretrieval of stored feedback data, configuration of operating parametersof the feedback controller 6152 and upgrade of firmware and/or othersoftware of the feedback controller 6152.

The feedback controller 6152 includes a housing 6162 and a plurality ofinput and output ports, such as a video input 6164, a video output 6166,and a HUD display output 6168. The feedback controller 6152 alsoincludes a screen for displaying status information concerning thefeedback controller 6152. Further examples are disclosed in U.S. Pat.No. 8,960,520, entitled METHOD AND APPARATUS FOR DETERMINING PARAMETERSOF LINEAR MOTION IN A SURGICAL INSTRUMENT, which issued on Feb. 24,2015, which is herein incorporated by reference in its entirety.

Visualization System

During a surgical procedure, a surgeon may be required to manipulatetissues to effect a desired medical outcome. The actions of the surgeonare limited by what is visually observable in the surgical site. Thus,the surgeon may not be aware, for example, of the disposition ofvascular structures that underlie the tissues being manipulated duringthe procedure. Since the surgeon is unable to visualize the vasculaturebeneath a surgical site, the surgeon may accidentally sever one or morecritical blood vessels during the procedure. The solution is a surgicalvisualization system that can acquire imaging data of the surgical sitefor presentation to a surgeon, in which the presentation can includeinformation related to the presence and depth of vascular structureslocated beneath the surface of a surgical site.

In one aspect, the surgical hub 106 incorporates a visualization system108 to acquire imaging data during a surgical procedure. Thevisualization system 108 may include one or more illumination sourcesand one or more light sensors. The one or more illumination sources andone or more light sensors may be incorporated together into a singledevice or may comprise one or more separate devices. The one or moreillumination sources may be directed to illuminate portions of thesurgical field. The one or more light sensors may receive lightreflected or refracted from the surgical field including light reflectedor refracted from tissue and/or surgical instruments. The followingdescription includes all of the hardware and software processingtechniques disclosed above and in those applications incorporated hereinby reference as presented above.

In some aspects, the visualization system 108 may be integrated into asurgical system 100 as disclosed above and depicted in FIGS. 1 and 2 .In addition to the visualization system 108, the surgical system 100 mayinclude one or more hand-held intelligent instruments 112, amulti-functional robotic system 110, one or more visualization systems108, and a centralized surgical hub system 106, among other components.The centralized surgical hub system 106 may control several functions adisclosed above and also depicted in FIG. 3 . In one non-limitingexample, such functions may include supplying and controlling power toany number of powered surgical devices. In another non-limiting example,such functions may include controlling fluid supplied to and evacuatedfrom the surgical site. The centralized surgical hub system 106 may alsobe configured to manage and analyze data received from any of thesurgical system components as well as communicate data and otherinformation among and between the components of the surgical system. Thecentralized surgical hub system 106 may also be in data communicationwith a cloud computing system 104 as disclosed above and depicted, forexample, in FIG. 1 .

In some non-limiting examples, imaging data generated by thevisualization system 108 may be analyzed by on-board computationalcomponents of the visualization system 108, and analysis results may becommunicated to the centralized surgical hub 106. In alternativenon-limiting examples, the imaging data generated by the visualizationsystem 108 may be communicated directly to the centralized surgical hub106 where the data may be analyzed by computational components in thehub system 106. The centralized surgical hub 106 may communicate theimage analysis results to any one or more of the other components of thesurgical system. In some other non-limiting examples, the centralizedsurgical hub may communicate the image data and/or the image analysisresults to the cloud computing system 104.

FIGS. 152A-D and FIGS. 153A-F depict various aspects of one example of avisualization system 2108 that may be incorporated into a surgicalsystem. The visualization system 2108 may include an imaging controlunit 2002 and a hand unit 2020. The imaging control unit 2002 mayinclude one or more illumination sources, a power supply for the one ormore illumination sources, one or more types of data communicationinterfaces (including USB, Ethernet, or wireless interfaces 2004), andone or more a video outputs 2006. The imaging control unit 2002 mayfurther include an interface, such as a USB interface 2010, configuredto transmit integrated video and image capture data to a USB enableddevice. The imaging control unit 2002 may also include one or morecomputational components including, without limitation, a processorunit, a transitory memory unit, a non-transitory memory unit, an imageprocessing unit, a bus structure to form data links among thecomputational components, and any interface (e.g. input and/or output)devices necessary to receive information from and transmit informationto components not included in the imaging control unit. Thenon-transitory memory may further contain instructions that whenexecuted by the processor unit, may perform any number of manipulationsof data that may be received from the hand unit 2020 and/orcomputational devices not included in the imaging control unit.

The illumination sources may include a white light source 2012 and oneor more laser light sources. The imaging control unit 2002 may includeone or more optical and/or electrical interfaces for optical and/orelectrical communication with the hand unit 2020. The one or more laserlight sources may include, as non-limiting examples, any one or more ofa red laser light source, a green laser light source, a blue laser lightsource, an infrared laser light source, and an ultraviolet laser lightsource. In some non-limiting examples, the red laser light source maysource illumination having a peak wavelength that may range between 635nm and 660 nm, inclusive. Non-limiting examples of a red laser peakwavelength may include about 635 nm, about 640 nm, about 645 nm, about650 nm, about 655 nm, about 660 nm, or any value or range of valuestherebetween. In some non-limiting examples, the green laser lightsource may source illumination having a peak wavelength that may rangebetween 520 nm and 532 nm, inclusive. Non-limiting examples of a greenlaser peak wavelength may include about 520 nm, about 522 nm, about 524nm, about 526 nm, about 528 nm, about 530 nm, about 532 nm, or any valueor range of values therebetween. In some non-limiting examples, the bluelaser light source may source illumination having a peak wavelength thatmay range between 405 nm and 445 nm, inclusive. Non-limiting examples ofa blue laser peak wavelength may include about 405 nm, about 410 nm,about 415 nm, about 420 nm, about 425 nm, about 430 nm, about 435 nm,about 440 nm, about 445 nm, or any value or range of valuestherebetween. In some non-limiting examples, the infrared laser lightsource may source illumination having a peak wavelength that may rangebetween 750 nm and 3000 nm, inclusive. Non-limiting examples of aninfrared laser peak wavelength may include about 750 nm, about 1000 nm,about 1250 nm, about 1500 nm, about 1750 nm, about 2000 nm, about 2250nm, about 2500 nm, about 2750 nm, 3000 nm, or any value or range ofvalues therebetween. In some non-limiting examples, the ultravioletlaser light source may source illumination having a peak wavelength thatmay range between 200 nm and 360 nm, inclusive. Non-limiting examples ofan ultraviolet laser peak wavelength may include about 200 nm, about 220nm, about 240 nm, about 260 nm, about 280 nm, about 300 nm, about 320nm, about 340 nm, about 360 nm, or any value or range of valuestherebetween.

In one non-limiting aspect, the hand unit 2020 may include a body 2021,a camera scope cable 2015 attached to the body 2021, and an elongatedcamera probe 2024. The body 2021of the hand unit 2020 may include handunit control buttons 2022 or other controls to permit a healthprofessional using the hand unit 2020 to control the operations of thehand unit 2020 or other components of the imaging control unit 2002,including, for example, the light sources. The camera scope cable 2015may include one or more electrical conductors and one or more opticalfibers. The camera scope cable 2015 may terminate with a camera headconnector 2008 at a proximal end in which the camera head connector 2008is configured to mate with the one or more optical and/or electricalinterfaces of the imaging control unit 2002. The electrical conductorsmay supply power to the hand unit 2020, including the body 2021 and theelongated camera probe 2024, and/or to any electrical componentsinternal to the hand unit 2020 including the body 2021 and/or elongatedcamera probe 2024. The electrical conductors may also serve to providebi-directional data communication between any one or more components thehand unit 2020 and the imaging control unit 2002. The one or moreoptical fibers may conduct illumination from the one or moreillumination sources in the imaging control unit 2002 through the handunit body 2021 and to a distal end of the elongated camera probe 2024.In some non-limiting aspects, the one or more optical fibers may alsoconduct light reflected or refracted from the surgical site to one ormore optical sensors disposed in the elongated camera probe 2024, thehand unit body 2021, and/or the imaging control unit 2002.

FIG. 152B (a top plan view) depicts in more detail some aspects of ahand unit 2020 of the visualization system 2108. The hand unit body 2021may be constructed of a plastic material. The hand unit control buttons2022 or other controls may have a rubber overmolding to protect thecontrols while permitting them to be manipulated by the surgeon. Thecamera scope cable 2015 may have optical fibers integrated withelectrical conductors, and the camera scope cable 2015 may have aprotective and flexible overcoating such as PVC. In some non-limitingexamples, the camera scope cable 2015 may be about 10 ft. long to permitease of use during a surgical procedure. The length of the camera scopecable 2015 may range from about 5 ft. to about 15 ft. Non-limitingexamples of a length of the camera scope cable 2015 may be about 5 ft.,about 6 ft., about 7 ft., about 8 ft., about 9 ft., about 10 ft., about11 ft., about 12 ft., about 13 ft., about 14 ft., about 15 ft., or anylength or range of lengths therebetween. The elongated camera probe 2024may be fabricated from a rigid material such as stainless steel. In someaspects, the elongated camera probe 2024 may be joined with the handunit body 2021 via a rotatable collar 2026. The rotatable collar 2026may permit the elongated camera probe 2024 to be rotated with respect tothe hand unit body 2021. In some aspects, the elongated camera probe2024 may terminate at a distal end with a plastic window 2028 sealedwith epoxy.

The side plan view of the hand unit, depicted in FIG. 152C illustratesthat a light or image sensor 2030 maybe disposed at a distal end 2032 aof the elongated camera probe or within the hand unit body 2032 b. Insome alternative aspects, the light or image sensor 2030 may be disposewith additional optical elements in the imaging control unit 2002. FIG.152C further depicts an example of a light sensor 2030 comprising a CMOSimage sensor 2034 disposed within a mount 2036 having a radius of about4 mm. FIG. 152D illustrates aspects of the CMOS image sensor 2034,depicting the active area 2038 of the image sensor. Although the CMOSimage sensor in FIG. 152C is depicted to be disposed within a mount 2036having a radius of about 4 mm, it may be recognized that such a sensorand mount combination may be of any useful size to be disposed withinthe elongated camera probe 2024, the hand unit body 2021, or in theimage control unit 2002. Some non-limiting examples of such alternativemounts may include a 5.5 mm mount 2136 a, a 4 mm mount 2136 b, a 2.7 mmmount 2136 c, and a 2 mm mount 2136 d. It may be recognized that theimage sensor may also comprise a CCD image sensor. The CMOS or CCDsensor may comprise an array of individual light sensing elements(pixels).

FIGS. 153A-153F depict various aspects of some examples of illuminationsources and their control that may be incorporated into thevisualization system 2108.

FIG. 153A illustrates an aspect of a laser illumination system having aplurality of laser bundles emitting a plurality of wavelengths ofelectromagnetic energy. As can be seen in the figure, the illuminationsystem 2700 may comprise a red laser bundle 2720, a green laser bundle2730, and a blue laser bundle 2740 that are all optically coupledtogether though fiber optics 2755. As can be seen in the figure, each ofthe laser bundles may have a corresponding light sensing element orelectromagnetic sensor 2725, 2735, 2745 respectively, for sensing theoutput of the specific laser bundle or wavelength.

Additional disclosures regarding the laser illumination system depictedin FIG. 153A for use in a surgical visualization system 2108 may befound in U.S. Patent Application Publication No. 2014/0268860, entitledCONTROLLING THE INTEGRAL LIGHT ENERGY OF A LASER PULSE filed on Mar. 15,2014, which issued on Oct. 3, 2017 as U.S. Pat. No. 9,777,913, thecontents thereof being incorporated by reference herein in its entiretyand for all purposes.

FIG. 153B illustrates the operational cycles of a sensor used in rollingreadout mode. It will be appreciated that the x direction corresponds totime and the diagonal lines 2202 indicate the activity of an internalpointer that reads out each frame of data, one line at time. The samepointer is responsible for resetting each row of pixels for the nextexposure period. The net integration time for each row 2219 a-c isequivalent, but they are staggered in time with respect to one anotherdue to the rolling reset and read process. Therefore, for any scenarioin which adjacent frames are required to represent differentconstitutions of light, the only option for having each row beconsistent is to pulse the light between the readout cycles 2230 a-c.More specifically, the maximum available period corresponds to the sumof the blanking time plus any time during which optical black oroptically blind (OB) rows (2218, 2220) are serviced at the start or endof the frame.

FIG. 153B illustrates the operational cycles of a sensor used in rollingreadout mode or during the sensor readout 2200. The frame readout maystart at and may be represented by vertical line 2210. The read outperiod is represented by the diagonal or slanted line 2202. The sensormay be read out on a row by row basis, the top of the downwards slantededge being the sensor top row 2212 and the bottom of the downwardsslanted edge being the sensor bottom row 2214. The time between the lastrow readout and the next readout cycle may be called the blanking time2216 a-d. It may be understood that the blanking time 2216 a-d may bethe same between success readout cycles or it may differ between successreadout cycles. It should be noted that some of the sensor pixel rowsmight be covered with a light shield (e.g., a metal coating or any othersubstantially black layer of another material type). These covered pixelrows may be referred to as optical black rows 2218 and 2220. Opticalblack rows 2218 and 2220 may be used as input for correction algorithms.

As shown in FIG. 153B, these optical black rows 2218 and 2220 may belocated on the top of the pixel array or at the bottom of the pixelarray or at the top and the bottom of the pixel array. In some aspects,it may be desirable to control the amount of electromagnetic radiation,e.g., light, that is exposed to a pixel, thereby integrated oraccumulated by the pixel. It will be appreciated that photons areelementary particles of electromagnetic radiation. Photons areintegrated, absorbed, or accumulated by each pixel and converted into anelectrical charge or current. In some aspects, an electronic shutter orrolling shutter may be used to start the integration time (2219 a-c) byresetting the pixel. The light will then integrate until the nextreadout phase. In some aspects, the position of the electronic shuttercan be moved between two readout cycles 2202 in order to control thepixel saturation for a given amount of light. In some alternativeaspects lacking an electronic shutter, the integration time 2219 a-c ofthe incoming light may start during a first readout cycle 2202 and mayend at the next readout cycle 2202, which also defines the start of thenext integration. In some alternative aspects, the amount of lightaccumulated by each pixel may be controlled by a time during which lightis pulsed 2230 a-d during the blanking times 2216 a-d. This ensures thatall rows see the same light issued from the same light pulse 2230 a-c.In other words, each row will start its integration in a first darkenvironment 2231, which may be at the optical black back row 2220 ofread out frame (m) for a maximum light pulse width, and will thenreceive a light strobe and will end its integration in a second darkenvironment 2232, which may be at the optical black front row 2218 ofthe next succeeding read out frame (m+1) for a maximum light pulsewidth. Thus, the image generated from the light pulse 2230 a-c will besolely available during frame (m+1) readout without any interferencewith frames (m) and (m+2).

It should be noted that the condition to have a light pulse 2230 a-c tobe read out only in one frame and not interfere with neighboring framesis to have the given light pulse 2230 a-c firing during the blankingtime 2216. Because the optical black rows 2218, 2220 are insensitive tolight, the optical black back rows 2220 time of frame (m) and theoptical black front rows 2218 time of frame (m+1) can be added to theblanking time 2216 to determine the maximum range of the firing time ofthe light pulse 2230.

In some aspects, FIG. 153B depicts an example of a timing diagram forsequential frame captures by a conventional CMOS sensor. Such a CMOSsensor may incorporate a Bayer pattern of color filters, as depicted inFIG. 153C. It is recognized that the Bayer pattern provides for greaterluminance detail than chrominance. It may further be recognized that thesensor has a reduced spatial resolution since a total of 4 adjacentpixels are required to produce the color information for the aggregatespatial portion of the image. In an alternative approach, the colorimage may be constructed by rapidly strobing the visualized area at highspeed with a variety of optical sources (either laser or light-emittingdiodes) having different central optical wavelengths.

The optical strobing system may be under the control of the camerasystem, and may include a specially designed CMOS sensor with high speedreadout. The principal benefit is that the sensor can accomplish thesame spatial resolution with significantly fewer pixels compared withconventional Bayer or 3-sensor cameras. Therefore, the physical spaceoccupied by the pixel array may be reduced. The actual pulse periods(2230 a-c) may differ within the repeating pattern, as illustrated inFIG. 153B. This is useful for, e.g., apportioning greater time to thecomponents that require the greater light energy or those having theweaker sources. As long as the average captured frame rate is an integermultiple of the requisite final system frame rate, the data may simplybe buffered in the signal processing chain as appropriate.

The facility to reduce the CMOS sensor chip-area to the extent allowedby combining all of these methods is particularly attractive for smalldiameter (˜3-10 mm) endoscopy. In particular, it allows for endoscopedesigns in which the sensor is located in the space-constrained distalend, thereby greatly reducing the complexity and cost of the opticalsection, while providing high definition video. A consequence of thisapproach is that to reconstruct each final, full color image, requiresthat data be fused from three separate snapshots in time. Any motionwithin the scene, relative to the optical frame of reference of theendoscope, will generally degrade the perceived resolution, since theedges of objects appear at slightly different locations within eachcaptured component. In this disclosure, a means of diminishing thisissue is described which exploits the fact that spatial resolution ismuch more important for luminance information, than for chrominance.

The basis of the approach is that, instead of firing monochromatic lightduring each frame, combinations of the three wavelengths are used toprovide all of the luminance information within a single image. Thechrominance information is derived from separate frames with, e.g., arepeating pattern such as Y-Cb-Y-Cr (FIG. 153D). While it is possible toprovide pure luminance data by a shrewd choice of pulse ratios, the sameis not true of chrominance.

In one aspect, as illustrated in FIG. 153D, an endoscopic system 2300 amay comprise a pixel array 2302 a having uniform pixels and the system2300 a may be operated to receive Y (luminance pulse) 2304 a, Cb(ChromaBlue) 2306 a and Cr (ChromaRed) 2308 a pulses.

To complete a full color image requires that the two components ofchrominance also be provided. However, the same algorithm that wasapplied for luminance cannot be directly applied for chrominance imagessince it is signed, as reflected in the fact that some of the RGBcoefficients are negative. The solution to this is to add a degree ofluminance of sufficient magnitude that all of the final pulse energiesbecome positive. As long as the color fusion process in the ISP is awareof the composition of the chrominance frames, they can be decoded bysubtracting the appropriate amount of luminance from a neighboringframe. The pulse energy proportions are given by:

Y=0.183·R+0.614·G+0.062·B

Cb=γ·Y−0.101·R−0.339·G+0.439·B

Cr=δ·Y+0.439·R−0.399·G−0.040·B

where

λ≥0.399/0.614=0.552

δ≥0.399/0.614=0.650

It turns out that if the λ factor is equal to 0.552; both the red andthe green components are exactly cancelled, in which case the Cbinformation can be provided with pure blue light. Similarly, settingδ=0.650 cancels out the blue and green components for Cr which becomespure red. This particular example is illustrated in FIG. 153E, whichalso depicts λ and δ as integer multiples of 1/2⁸. This is a convenientapproximation for the digital frame reconstruction.

In the case of the Y-Cb-Y-Cr pulsing scheme, the image data is alreadyin the YCbCr space following the color fusion. Therefore, in this caseit makes sense to perform luminance and chrominance based operations upfront, before converting back to linear RGB to perform the colorcorrection etc.

The color fusion process is more straightforward than de-mosaic, whichis necessitated by the Bayer pattern (see FIG. 153C), since there is nospatial interpolation. It does require buffering of frames though inorder to have all of the necessary information available for each pixel.In one general aspect, data for the Y-Cb-Y-Cr pattern may be pipelinedto yield one full color image per two raw captured images. This isaccomplished by using each chrominance sample twice. In FIG. 153F thespecific example of a 120 Hz frame capture rate providing 60 Hz finalvideo is depicted.

Additional disclosures regarding the control of the laser components ofan illumination system as depicted in FIGS. 153B-153F for use in asurgical visualization system 108 may be found in U.S. PatentApplication Publication No. 2014/0160318, entitled YCBCR PULSEDILLUMINATION SCHEME IN A LIGHT DEFICIENT ENVIRONMENT, filed on Jul. 26,2013, which issued on Dec. 6, 2016 as U.S. Pat. No. 9,516,239, and U.S.Patent Application Publication No. 2014/0160319, entitled CONTINUOUSVIDEO IN A LIGHT DEFICIENT ENVIRONMENT, filed on Jul. 26, 2013, whichissued on Aug. 22, 2017 as U.S. Pat. No. 9,743,016, the contents thereofbeing incorporated by reference herein in their entirety and for allpurposes.

Subsurface Vascular Imaging

During a surgical procedure, a surgeon may be required to manipulatetissues to effect a desired medical outcome. The actions of the surgeonare limited by what is visually observable in the surgical site. Thus,the surgeon may not be aware, for example, of the disposition ofvascular structures that underlie the tissues being manipulated duringthe procedure.

Since the surgeon is unable to visualize the vasculature beneath asurgical site, the surgeon may accidentally sever one or more criticalblood vessels during the procedure.

Therefore, it is desirable to have a surgical visualization system thatcan acquire imaging data of the surgical site for presentation to asurgeon in which the presentation can include information related to thepresence of vascular structures located beneath the surface of asurgical site.

Some aspects of the present disclosure further provide for a controlcircuit configured to control the illumination of a surgical site usingone or more illumination sources such as laser light sources and toreceive imaging data from one or more image sensors. In some aspects,the present disclosure provides for a non-transitory computer readablemedium storing computer readable instructions that, when executed, causea device to detect a blood vessel in a tissue and determine its depthbelow the surface of the tissue.

In some aspects, a surgical image acquisition system may include aplurality of illumination sources wherein each illumination source isconfigured to emit light having a specified central wavelength, a lightsensor configured to receive a portion of the light reflected from atissue sample when illuminated by the one or more of the plurality ofillumination sources, and a computing system. The computing system maybe configured to: receive data from the light sensor when the tissuesample is illuminated by each of the plurality of illumination sources;determine a depth location of a structure within the tissue sample basedon the data received by the light sensor when the tissue sample isilluminated by each of the plurality of illumination sources, andcalculate visualization data regarding the structure and the depthlocation of the structure. In some aspects, the visualization data mayhave a data format that may be used by a display system, and thestructure may comprise one or more vascular tissues.

Vascular Imaging Using NIR Spectroscopy

In one aspect, a surgical image acquisition system may include anindependent color cascade of illumination sources comprising visiblelight and light outside of the visible range to image one or moretissues within a surgical site at different times and at differentdepths. The surgical image acquisition system may further detect orcalculate characteristics of the light reflected and/or refracted fromthe surgical site. The characteristics of the light may be used toprovide a composite image of the tissue within the surgical site as wellas provide an analysis of underlying tissue not directly visible at thesurface of the surgical site. The surgical image acquisition system maydetermine tissue depth location without the need for separatemeasurement devices.

In one aspect, the characteristic of the light reflected and/orrefracted from the surgical site may be an amount of absorbance of lightat one or more wavelengths. Various chemical components of individualtissues may result in specific patterns of light absorption that arewavelength dependent.

In one aspect, the illumination sources may comprise a red laser sourceand a near infrared laser source, wherein the one or more tissues to beimaged may include vascular tissue such as veins or arteries. In someaspects, red laser sources (in the visible range) may be used to imagesome aspects of underlying vascular tissue based on spectroscopy in thevisible red range. In some non-limiting examples, a red laser lightsource may source illumination having a peak wavelength that may rangebetween 635 nm and 660 nm, inclusive. Non-limiting examples of a redlaser peak wavelength may include about 635 nm, about 640 nm, about 645nm, about 650 nm, about 655 nm, about 660 nm, or any value or range ofvalues therebetween. In some other aspects, near infrared laser sourcesmay be used to image underlying vascular tissue based on near infraredspectroscopy. In some non-limiting examples, a near infrared lasersource may emit illumination have a wavelength that may range between750-3000 nm, inclusive. Non-limiting examples of an infrared laser peakwavelength may include about 750 nm, about 1000 nm, about 1250 nm, about1500 nm, about 1750 nm, about 2000 nm, about 2250 nm, about 2500 nm,about 2750 nm, 3000 nm, or any value or range of values therebetween. Itmay be recognized that underlying vascular tissue may be probed using acombination of red and infrared spectroscopy. In some examples, vasculartissue may be probed using a red laser source having a peak wavelengthat about 660 nm and a near IR laser source having a peak wavelength atabout 750 nm or at about 850 nm.

Near infrared spectroscopy (NIRS) is a non-invasive technique thatallows determination of tissue oxygenation based on spectro-photometricquantitation of oxy- and deoxyhemoglobin within a tissue. In someaspects, NIRS can be used to image vascular tissue directly based on thedifference in illumination absorbance between the vascular tissue andnon-vascular tissue. Alternatively, vascular tissue can be indirectlyvisualized based on a difference of illumination absorbance of bloodflow in the tissue before and after the application of physiologicalinterventions, such as arterial and venous occlusions methods.

Instrumentation for near-IR (NIR) spectroscopy may be similar toinstruments for the UV-visible and mid-IR ranges. Such spectroscopicinstruments may include an illumination source, a detector, and adispersive element to select a specific near-IR wavelength forilluminating the tissue sample. In some aspects, the source may comprisean incandescent light source or a quartz halogen light source. In someaspects, the detector may comprise semiconductor (for example, anInGaAs) photodiode or photo array. In some aspects, the dispersiveelement may comprise a prism or, more commonly, a diffraction grating.Fourier transform NIR instruments using an interferometer are alsocommon, especially for wavelengths greater than about 1000 nm. Dependingon the sample, the spectrum can be measured in either reflection ortransmission mode.

FIG. 154 depicts schematically one example of instrumentation 2400similar to instruments for the UV-visible and mid-IR ranges for NIRspectroscopy. A light source 2402 may emit a broad spectral range ofillumination 2404 that may impinge upon a dispersive element 2406 (suchas a prism or a diffraction grating). The dispersive element 2406 mayoperate to select a narrow wavelength portion 2408 of the light emittedby the broad spectrum light source 2402, and the selected portion 2408of the light may illuminate the tissue 2410. The light reflected fromthe tissue 2412 may be directed to a detector 2416 (for example, bymeans of a dichroic mirror 2414) and the intensity of the reflectedlight 2412 may be recorded. The wavelength of the light illuminating thetissue 2410 may be selected by the dispersive element 2406. In someaspects, the tissue 2410 may be illuminated only by a single narrowwavelength portion 2408 selected by the dispersive element 2406 form thelight source 2402. In other aspects, the tissue 2410 may be scanned witha variety of narrow wavelength portions 2408 selected by the dispersiveelement 2406. In this manner, a spectroscopic analysis of the tissue2410 may be obtained over a range of NIR wavelengths.

FIG. 155 depicts schematically one example of instrumentation 2430 fordetermining NIRS based on Fourier transform infrared imaging. In FIG.155 , a laser source emitting 2432 light in the near IR range 2434illuminates a tissue sample 2440. The light reflected 2436 by the tissue2440 is reflected 2442 by a mirror, such as a dichroic mirror 2444, to abeam splitter 2446. The beam splitter 2446 directs one portion of thelight 2448 reflected 2436 by the tissue 2440 to a stationary mirror 2450and one portion of the light 2452 reflected 2436 by the tissue 2440 amoving mirror 2454. The moving mirror 2454 may oscillate in positionbased on an affixed piezoelectric transducer activated by a sinusoidalvoltage having a voltage frequency. The position of the moving mirror2454 in space corresponds to the frequency of the sinusoidal activationvoltage of the piezoelectric transducer. The light reflected from themoving mirror and the stationary mirror may be recombined 2458 at thebeam splitter 2446 and directed to a detector 2456. Computationalcomponents may receive the signal output of the detector 2456 andperform a Fourier transform (in time) of the received signal. Becausethe wavelength of the light received from the moving mirror 2454 variesin time with respect to the wavelength of the light received from thestationary mirror 2450, the time-based Fourier transform of therecombined light corresponds to a wavelength-based Fourier transform ofthe recombined light 2458. In this manner, a wavelength-based spectrumof the light reflected from the tissue 2440 may be determined andspectral characteristics of the light reflected 2436 from the tissue2440 may be obtained. Changes in the absorbance of the illumination inspectral components from the light reflected from the tissue 2440 maythus indicate the presence or absence of tissue having specific lightabsorbing properties (such as hemoglobin).

An alternative to near infrared light to determine hemoglobinoxygenation would be the use of monochromatic red light to determine thered light absorbance characteristics of hemoglobin. The absorbancecharacteristics of red light having a central wavelength of about 660 nmby the hemoglobin may indicate if the hemoglobin is oxygenated (arterialblood) or deoxygenated (venous blood).

In some alternative surgical procedures, contrasting agents can be usedto improve the data that is collected on oxygenation and tissue oxygenconsumption. In one non-limiting example, NIRS techniques may be used inconjunction with a bolus injection of a near-IR contrast agent such asindocyanine green (ICG) which has a peak absorbance at about 800 nm. ICGhas been used in some medical procedures to measure cerebral blood flow.

Vascular Imaging Using Laser Doppler Flowmetry

In one aspect, the characteristic of the light reflected and/orrefracted from the surgical site may be a Doppler shift of the lightwavelength from its illumination source.

Laser Doppler flowmetry may be used to visualize and characterized aflow of particles moving relative to an effectively stationarybackground. Thus, laser light scattered by moving particles, such asblood cells, may have a different wavelength than that of the originalilluminating laser source. In contrast, laser light scattered by theeffectively stationary background (for example, the vascular tissue) mayhave the same wavelength of that of the original illuminating lasersource. The change in wavelength of the scattered light from the bloodcells may reflect both the direction of the flow of the blood cellsrelative to the laser source as well as the blood cell velocity. FIGS.156A-C illustrate the change in wavelength of light scattered from bloodcells that may be moving away from (FIG. 156A) or towards (FIG. 156C)the laser light source.

In each of FIGS. 156A-C, the original illuminating light 2502 isdepicted having a relative central wavelength of 0. It may be observedfrom FIG. 156A that light scattered from blood cells moving away fromthe laser source 2504 has a wavelength shifted by some amount 2506 to agreater wavelength relative to that of the laser source (and is thus redshifted). It may also be observed from FIG. 156C that light scatteredfrom blood cells moving towards from the laser source 2508 has awavelength shifted by some amount 2510 to a shorter wavelength relativeto that of the laser source (and is thus blue shifted). The amount ofwavelength shift (for example 2506 or 2510) may be dependent on thevelocity of the motion of the blood cells. In some aspects, an amount ofa red shift (2506) of some blood cells may be about the same as theamount of blue shift (2510) of some other blood cells. Alternatively, anamount of a red shift (2506) of some blood cells may differ from theamount of blue shift (2510) of some other blood cells Thus, the velocityof the blood cells flowing away from the laser source as depicted inFIG. 156A may be less than the velocity of the blood cells flowingtowards the laser source as depicted in FIG. 156C based on the relativemagnitude of the wavelength shifts (2506 and 2510). In contrast, and asdepicted in FIG. 156B, light scattered from tissue not moving relativeto the laser light source (for example blood vessels 2512 ornon-vascular tissue 2514) may not demonstrate any change in wavelength.

FIG. 157 depicts an aspect of instrumentation 2530 that may be used todetect a Doppler shift in laser light scattered from portions of atissue 2540. Light 2534 originating from a laser 2532 may pass through abeam splitter 2544. Some portion of the laser light 2536 may betransmitted by the beam splitter 2544 and may illuminate tissue 2540.Another portion of the laser light may be reflected 2546 by the beamsplitter 2544 to impinge on a detector 2550. The light back-scattered2542 by the tissue 2540 may be directed by the beam splitter 2544 andalso impinge on the detector 2550. The combination of the light 2534originating from the laser 2532 with the light back-scattered 2542 bythe tissue 2540 may result in an interference pattern detected by thedetector 2550. The interference pattern received by the detector 2550may include interference fringes resulting from the combination of thelight 2534 originating from the laser 2532 and the Doppler shifted (andthus wavelength shifted) light back-scattered 2452 from the tissue 2540.

It may be recognized that back-scattered light 2542 from the tissue 2540may also include back scattered light from boundary layers within thetissue 2540 and/or wavelength-specific light absorption by materialwithin the tissue 2540. As a result, the interference pattern observedat the detector 2550 may incorporate interference fringe features fromthese additional optical effects and may therefore confound thecalculation of the Doppler shift unless properly analyzed.

FIG. 158 depicts some of these additional optical effects. It is wellknown that light traveling through a first optical medium having a firstrefractive index, n1, may be reflected at an interface with a secondoptical medium having a second refractive index, n2. The lighttransmitted through the second optical medium will have a transmissionangle relative to the interface that differs from the angle of theincident light based on a difference between the refractive indices n1and n2 (Snell's Law). FIG. 158 illustrates the effect of Snell's Law onlight impinging on the surface of a multi-component tissue 2150, as maybe presented in a surgical field. The multi-component tissue 2150 may becomposed of an outer tissue layer 2152 having a refractive index n1 anda buried tissue, such as a blood vessel having a vessel wall 2156. Theblood vessel wall 2156 may be characterized by a refractive index n2.Blood may flow within the lumen of the blood vessel 2160. In someaspects, it may be important during a surgical procedure to determinethe position of the blood vessel 2160 below the surface 2154 of theouter tissue layer 2152 and to characterize the blood flow using Dopplershift techniques.

An incident laser light 2170 a may be used to probe for the blood vessel2160 and may be directed on the top surface 2154 of the outer tissuelayer 2152. A portion 2172 of the incident laser light 2170 a may bereflected at the top surface 2154. Another portion 2170 b of theincident laser light 2170 a may penetrate the outer tissue layer 2152.The reflected portion 2172 at the top surface 2154 of the outer tissuelayer 2152 has the same path length of the incident light 2170 a, andtherefore has the same wavelength and phase of the incident light 2170a. However, the portion 2170 b of light transmitted into the outertissue layer 2152 will have a transmission angle that differs from theincidence angle of the light impinging on the tissue surface because theouter tissue layer 2152 has an index of refraction n1 that differs fromthe index of refraction of air.

If the portion of light transmitted through the outer tissue layer 2152impinges on a second tissue surface 2158, for example of the bloodvessel wall 2156, some portion 2174 a,b of light will be reflected backtowards the source of the incident light 2170 a. The light thusreflected 2174 a at the interface between the outer tissue layer 2152and the blood vessel wall 2156 will have the same wavelength as theincident light 2170 a, but will be phase shifted due to the change inthe light path length. Projecting the light reflected 2174 a,b from theinterface between the outer tissue layer 2152 and the blood vessel wall2156 along with the incident light on the sensor, will produce aninterference pattern based on the phase difference between the two lightsources.

Further, a portion of the incident light 2170 c may be transmittedthrough the blood vessel wall 2156 and penetrate into the blood vessellumen 2160. This portion of the incident light 2170 c may interact withthe moving blood cells in the blood vessel lumen 2160 and may bereflected back 2176 a-c towards the source of the impinging light havinga wavelength Doppler shifted according to the velocity of the bloodcells, as disclosed above. The Doppler shifted light reflected 2176 a-cfrom the moving blood cells may be projected along with the incidentlight on the sensor, resulting in an interference pattern having afringe pattern based on the wavelength difference between the two lightsources.

In FIG. 158 , a light path 2178 is presented of light impinging on thered blood cells in the blood vessel lumen 2160 if there are no changesin refractive index between the emitted light and the light reflected bythe moving blood cells. In this example, only a Doppler shift in thereflected light wavelength can be detected. However, the light reflectedby the blood cells (2176 a-c) may incorporate phase changes due to thevariation in the tissue refractive indices in addition to the wavelengthchanges due to the Doppler Effect.

Thus, it may be understood that if the light sensor receives theincident light, the light reflected from one or more tissue interfaces(2172, and 2174 a,b) and the Doppler shifted light from the blood cells(2176 a-c), the interference pattern thus produced on the light sensormay include the effects due to the Doppler shift (change in wavelength)as well as the effects due to the change in refractive index within thetissue (change in phase). As a result, a Doppler analysis of the lightreflected by the tissue sample may produce erroneous results if theeffects due to changes in the refractive index within the sample are notcompensated for.

FIG. 159 illustrates an example of the effects on a Doppler analysis oflight that impinge 2250 on a tissue sample to determine the depth andlocation of an underlying blood vessel. If there is no interveningtissue between the blood vessel and the tissue surface, the interferencepattern detected at the sensor may be due primarily to the change inwavelength reflected from the moving blood cells. As a result, aspectrum 2252 derived from the interference pattern may generallyreflect only the Doppler shift of the blood cells. However, if there isintervening tissue between the blood vessel and the tissue surface, theinterference pattern detected at the sensor may be due to a combinationof the change in wavelength reflected from the moving blood cells andthe phase shift due to the refractive index of the intervening tissue. Aspectrum 2254 derived from such an interference pattern, may result inthe calculation of the Doppler shift that is confounded due to theadditional phase change in the reflected light. In some aspects, ifinformation regarding the characteristics (thickness and refractiveindex) of the intervening tissue is known, the resulting spectrum 2256may be corrected to provide a more accurate calculation of the change inwavelength.

It is recognized that the tissue penetration depth of light is dependenton the wavelength of the light used. Thus, the wavelength of the lasersource light may be chosen to detect particle motion (such a bloodcells) at a specific range of tissue depth. FIGS. 160A-C depictschematically a means for detect moving particles such as blood cells ata variety of tissue depths based on the laser light wavelength. Asillustrated in FIG. 160A, a laser source 2340 may direct an incidentbeam of laser light 2342 onto a surface 2344 of a surgical site. A bloodvessel 2346 (such as a vein or artery) may be disposed within the tissue2348 at some depth δ from the tissue surface. The penetration depth 2350of a laser into a tissue 2348 may be dependent at least in part on thelaser wavelength. Thus, laser light having a wavelength in the red rangeof about 635 nm to about 660 nm, may penetrate the tissue 2351 a to adepth of about 1 mm. Laser light having a wavelength in the green rangeof about 520 nm to about 532 nm may penetrate the tissue 2351 b to adepth of about 2-3 mm. Laser light having a wavelength in the blue rangeof about 405 nm to about 445 nm may penetrate the tissue 2351 c to adepth of about 4 mm or greater. In the example depicted in FIGS. 160A-C,a blood vessel 2346 may be located at a depth δ of about 2-3 mm belowthe tissue surface. Red laser light will not penetrate to this depth andthus will not detect blood cells flowing within this vessel. However,both green and blue laser light can penetrate this depth. Therefore,scattered green and blue laser light from the blood cells within theblood vessel 2346 may demonstrate a Doppler shift in wavelength.

FIG. 160B illustrates how a Doppler shift 2355 in the wavelength ofreflected laser light may appear. The emitted light (or laser sourcelight 2342) impinging on a tissue surface 2344 may have a centralwavelength 2352. For example, light from a green laser may have acentral wavelength 2352 within a range of about 520 nm to about 532 nm.The reflected green light may have a central wavelength 2354 shifted toa longer wavelength (red shifted) if the light was reflected from aparticle such as a red blood cell that is moving away from the detector.The difference between the central wavelength 2352 of the emitted laserlight and the central wavelength 2354 of the emitted laser lightcomprises the Doppler shift 2355.

As disclosed above with respect to FIGS. 158 and 159 , laser lightreflected from structures within a tissue 2348 may also show a phaseshift in the reflected light due to changes in the index of refractionarising from changes in tissue structure or composition. The emittedlight (or laser source light 2342) impinging on a tissue surface 2344may have a first phase characteristic 2356. The reflected laser lightmay have a second phase characteristic 2358. It may be recognized thatblue laser light that can penetrate tissue to a depth of about 4 mm orgreater 2351 c may encounter a greater variety of tissue structures thanred laser light (about 1 mm 2351 a) or green laser light (about 2-3 mm2351 b). Consequently, as illustrated in FIG. 160C, the phase shift 2358of reflected blue laser light may be significant at least due to thedepth of penetration.

FIG. 160D illustrates aspects of illuminating tissue by red 2360 a,green 2360 b and blue 2360 c laser light in a sequential manner. In someaspects, a tissue may be probed by red 2360 a, green 2360 b and blue2360 c laser illumination in a sequential manner. In some alternativeexamples, one or more combinations of red 2360 a, green 2360 b, and blue2360 c laser light, as depicted in FIGS. 153D-153F and disclosed above,may be used to illuminate the tissue according to a defined illuminationsequence. 30D illustrates the effect of such illumination on a CMOSimaging sensor 2362 a-d over time. Thus, at a first time t₁, the CMOSsensor 2362 a may be illuminated by the red 2360 a laser. At a secondtime t₂ the CMOS sensor 2362 b may be illuminated by the green 2360 blaser. At a third time t₃, the CMOS sensor 2362 c may be illuminated bythe blue 2360 c laser. The illumination cycle may then be repeatedstarting at a fourth time t₄ in which the CMOS sensor 2362 d may beilluminated by the red 2360 a lase again. It may be recognized thatsequential illumination of the tissue by laser illumination at differingwavelengths may permit a Doppler analysis at varying tissue depths overtime. Although red 2360 a, green 2360 b and blue 2360 c laser sourcesmay be used to illuminate the surgical site, it may be recognized thatother wavelengths outside of visible light (such as in the infrared orultraviolet regions) may be used to illuminate the surgical site forDoppler analysis.

FIG. 161 illustrates an example of a use of Doppler imaging to detectthe present of blood vessels not otherwise viewable at a surgical site2600. In FIG. 161 , a surgeon may wish to excise a tumor 2602 found inthe right superior posterior lobe 2604 of a lung. Because the lungs arehighly vascular, care must be taken to identify only those blood vesselsassociate with the tumor and to seal only those vessels withoutcompromising the blood flow to the non-affected portions of the lung. InFIG. 161 , the surgeon has identified the margin 2606 of the tumor 2604.The surgeon may then cut an initial dissected area 2608 in the marginregion 2606, and exposed blood vessels 2610 may be observed for cuttingand sealing. The Doppler imaging detector 2620 may be used to locate andidentify blood vessels not observable 2612 in the dissected area. Animaging system may receive data from the Doppler imaging detector 2620for analysis and display of the data obtained from the surgical site2600. In some aspects, the imaging system may include a display toillustrate the surgical site 2600 including a visible image of thesurgical site 2600 along with an image overlay of the hidden bloodvessels 2612 on the image of the surgical site 2600.

In the scenario disclosed above regarding FIG. 161 , a surgeon wishes tosever blood vessels that supply oxygen and nutrients to a tumor whilesparing blood vessels associated with non-cancerous tissue.Additionally, the blood vessels may be disposed at different depths inor around the surgical site 2600. The surgeon must therefore identifythe position (depth) of the blood vessels as well as determine if theyare appropriate for resection. FIG. 162 illustrates one method foridentifying deep blood vessels based on a Doppler shift of light fromblood cells flowing therethrough. As disclosed above, red laser lighthas a penetration depth of about 1 mm and green laser light has apenetration depth of about 2-3 mm. However, a blood vessel having abelow-surface depth of 4mm or more will be outside the penetrationdepths at these wavelengths. Blue laser light, however, can detect suchblood vessels based on their blood flow.

FIG. 162 depicts the Doppler shift of laser light reflected from a bloodvessel at a specific depth below a surgical site. The site may beilluminated by red laser light, green laser light, and blue laser light.The central wavelength 2630 of the illuminating light may be normalizedto a relative central 3631. If the blood vessel lies at a depth of 4 ormore mm below the surface of the surgical site, neither the red laserlight nor the green laser light will be reflected by the blood vessel.Consequently, the central wavelength 2632 of the reflected red light andthe central wavelength 2634 of the reflected green light will not differmuch from the central wavelength 2630 of the illuminating red light orgreen light, respectively. However, if the site is illuminated by bluelaser light, the central wavelength 2638 of the reflected blue light2636 will differ from the central wavelength 2630 of the illuminatingblue light. In some instances, the amplitude of the reflected blue light2636 may also be significantly reduced from the amplitude of theilluminating blue light. A surgeon may thus determine the presence of adeep lying blood vessel along with its approximate depth, and therebyavoiding the deep blood vessel during surface tissue dissection.

FIGS. 163 and 164 illustrates schematically the use of laser sourceshaving differing central wavelengths (colors) for determining theapproximate depth of a blood vessel beneath the surface of a surgicalsite. FIG. 163 depicts a first surgical site 2650 having a surface 2654and a blood vessel 2656 disposed below the surface 2654. In one method,the blood vessel 2656 may be identified based on a Doppler shift oflight impinging on the flow 2658 of blood cells within the blood vessel2656. The surgical site 2650 may be illuminated by light from a numberof lasers 2670, 2676, 2682, each laser being characterized by emittinglight at one of several different central wavelengths. As noted above,illumination by a red laser 2670 can only penetrate tissue by about 1mm. Thus, if the blood vessel 2656 was located at a depth of less than 1mm 2672 below the surface 2654, the red laser illumination would bereflected 2674 and a Doppler shift of the reflected red illumination2674 may be determined. Further, as noted above, illumination by a greenlaser 2676 can only penetrate tissue by about 2-3 mm. If the bloodvessel 2656 was located at a depth of about 2-3 mm 2678 below thesurface 2654, the green laser illumination would be reflected 2680 whilethe red laser illumination 2670 would not, and a Doppler shift of thereflected green illumination 2680 may be determined. However, asdepicted in FIG. 163 , the blood vessel 2656 is located at a depth ofabout 4 mm 2684 below the surface 2654. Therefore, neither the red laserillumination 2670 nor the green laser illumination 2676 would bereflected. Instead, only the blue laser illumination would be reflected2686 and a Doppler shift of the reflected blue illumination 2686 may bedetermined.

In contrast to the blood vessel 2656 depicted in FIG. 163 , the bloodvessel 2656′ depicted in FIG. 164 is located closer to the surface ofthe tissue at the surgical site. Blood vessel 2656′ may also bedistinguished from blood vessel 2656 in that blood vessel 2656′ isillustrated to have a much thicker wall 2657. Thus, blood vessel 2656′may be an example of an artery while blood vessel 2656 may be an exampleof a vein because arterial walls are known to be thicker than venouswalls. In some examples, arterial walls may have a thickness of about1.3 mm. As disclosed above, red laser illumination 2670′ can penetratetissue to a depth of about 1 mm 2672′. Thus, even if a blood vessel2656′ is exposed at a surgical site (see 2610 at FIG. 161 ), red laserlight that is reflected 2674′ from the surface of the blood vessel2656′, may not be able to visualize blood flow 2658′ within the bloodvessel 2656′ under a Doppler analysis due to the thickness of the bloodvessel wall 2657. However, as disclosed above, green laser lightimpinging 2676′ on the surface of a tissue may penetrate to a depth ofabout 2-3 mm 2678′. Further, blue laser light impinging 2682′ on thesurface of a tissue may penetrate to a depth of about 4 mm 2684′.Consequently, green laser light may be reflected 2680′ from the bloodcells flowing 2658′ within the blood vessel 2656′ and blue laser lightmay be reflected 2686′ from the blood cells flowing 2658′ within theblood vessel 2656′. As a result, a Doppler analysis of the reflectedgreen light 2680′ and reflected blue light 2686′ may provide informationregarding blood flow in near-surface blood vessel, especially theapproximate depth of the blood vessel.

As disclosed above, the depth of blood vessels below the surgical sitemay be probed based on wavelength-dependent Doppler imaging. The amountof blood flow through such a blood vessel may also be determined byspeckle contrast (interference) analysis. Doppler shift may indicate amoving particle with respect to a stationary light source. As disclosedabove, the Doppler wavelength shift may be an indication of the velocityof the particle motion. Individual particles such as blood cells may notbe separately observable. However, the velocity of each blood cell willproduce a proportional Doppler shift. An interference pattern may begenerated by the combination of the light back-scattered from multipleblood cells due to the differences in the Doppler shift of theback-scattered light from each of the blood cells. The interferencepattern may be an indication of the number density of blood cells withina visualization frame. The interference pattern may be termed specklecontrast. Speckle contrast analysis may be calculated using a full frame300×300 CMOS imaging array, and the speckle contrast may be directlyrelated to the amount of moving particles (for example blood cells)interacting with the laser light over a given exposure period.

A CMOS image sensor may be coupled to a digital signal processor (DSP).Each pixel of the sensor may be multiplexed and digitized. The Dopplershift in the light may be analyzed by looking at the source laser lightin comparison to the Doppler shifted light. A greater Doppler shift andspeckle may be related to a greater number of blood cells and theirvelocity in the blood vessel.

FIG. 165 depicts an aspect of a composite visual display 2800 that maybe presented a surgeon during a surgical procedure. The composite visualdisplay 2800 may be constructed by overlaying a white light image 2830of the surgical site with a Doppler analysis image 2850.

In some aspects, the white light image 2830 may portray the surgicalsite 2832, one or more surgical incisions 2834, and the tissue 2836readily visible within the surgical incision 2834. The white light image2830 may be generated by illuminating 2840 the surgical site 2832 with awhite light source 2838 and receiving the reflected white light 2842 byan optical detector. Although a white light source 2838 may be used toilluminate the surface of the surgical site, in one aspect, the surfaceof the surgical site may be visualized using appropriate combinations ofred 2854, green 2856, and blue 2858 laser light as disclosed above withrespect to FIGS. 153C-153F.

In some aspects, the Doppler analysis image 2850 may include bloodvessel depth information along with blood flow information 2852 (fromspeckle analysis). As disclosed above, blood vessel depth and blood flowvelocity may be obtained by illuminating the surgical site with laserlight of multiple wavelengths, and determining the blood vessel depthand blood flow based on the known penetration depth of the light of aparticular wavelength. In general, the surgical site 2832 may beilluminated by light emitted by one or more lasers such as a red leaser2854, a green laser 2856, and a blue laser 2858. A CMOS detector 2872may receive the light reflected back (2862, 2866, 2870) from thesurgical site 2832 and its surrounding tissue. The Doppler analysisimage 2850 may be constructed 2874 based on an analysis of the multiplepixel data from the CMOS detector 2872.

In one aspect, a red laser 2854 may emit red laser illumination 2860 onthe surgical site 2832 and the reflected light 2862 may reveal surfaceor minimally subsurface structures. In one aspect, a green laser 2856may emit green laser illumination 2864 on the surgical site 2832 and thereflected light 2866 may reveal deeper subsurface characteristics. Inanother aspect, a blue laser 2858 may emit blue laser illumination 2868on the surgical site 2832 and the reflected light 2870 may reveal, forexample, blood flow within deeper vascular structures. In addition, thespeckle contrast analysis my present the surgeon with informationregarding the amount and velocity of blood flow through the deepervascular structures.

Although not depicted in FIG. 165 , it may be understood that theimaging system may also illuminate the surgical site with light outsideof the visible range. Such light may include infrared light andultraviolet light. In some aspects, sources of the infrared light orultraviolet light may include broad-band wavelength sources (such as atungsten source, a tungsten-halogen source, or a deuterium source). Insome other aspects, the sources of the infrared or ultraviolet light mayinclude narrow-band wavelength sources (IR diode lasers, UV gas lasersor dye lasers).

FIG. 166 is a flow chart 2900 of a method for determining a depth of asurface feature in a piece of tissue. An image acquisition system mayilluminate 2910 a tissue with a first light beam having a first centralfrequency and receive 2912 a first reflected light from the tissueilluminated by the first light beam. The image acquisition system maythen calculate 2914 a first Doppler shift based on the first light beamand the first reflected light. The image acquisition system may thenilluminate 2916 the tissue with a second light beam having a secondcentral frequency and receive 2918 a second reflected light from thetissue illuminated by the second light beam. The image acquisitionsystem may then calculate 2920 a second Doppler shift based on thesecond light beam and the second reflected light. The image acquisitionsystem may then calculate 2922 a depth of a tissue feature based atleast in part on the first central wavelength, the first Doppler shift,the second central wavelength, and the second Doppler shift. In someaspects, the tissue features may include the presence of movingparticles, such as blood cells moving within a blood vessel, and adirection and velocity of flow of the moving particles. It may beunderstood that the method may be extended to include illumination ofthe tissue by any one or more additional light beams. Further, thesystem may calculate an image comprising a combination of an image ofthe tissue surface and an image of the structure disposed within thetissue.

In some aspects, multiple visual displays may be used. For example, a 3Ddisplay may provide a composite image displaying the combined whitelight (or an appropriate combination of red, green, and blue laserlight) and laser Doppler image. Additional displays may provide only thewhite light display or a displaying showing a composite white lightdisplay and an NIRS display to visualize only the blood oxygenationresponse of the tissue. However, the NIRS display may not be requiredevery cycle allowing for response of tissue.

Subsurface Tissue Characterization Using Multispectral OCT

During a surgical procedure, the surgeon may employ “smart” surgicaldevices for the manipulation of tissue. Such devices may be considered“smart” in that they include automated features to direct, control,and/or vary the actions of the devices based parameters relevant totheir uses. The parameters may include the type and/or composition ofthe tissue being manipulated. If the type and/or composition of thetissue being manipulated is unknown, the actions of the smart devicesmay be inappropriate for the tissue being manipulated. As a result,tissues may be damaged or the manipulation of the tissue may beineffective due to inappropriate settings of the smart device.

The surgeon may manually attempt to vary the parameters of the smartdevice in a trial-and-error manner, resulting in an inefficient andlengthy surgical procedure.

Therefore, it is desirable to have a surgical visualization system thatcan probe tissue structures underlying a surgical site to determinetheir structural and compositional characteristics, and to provide suchdata to smart surgical instruments being used in a surgical procedure.

Some aspects of the present disclosure further provide for a controlcircuit configured to control the illumination of a surgical site usingone or more illumination sources such as laser light sources and toreceive imaging data from one or more image sensors. In some aspects,the present disclosure provides for a non-transitory computer readablemedium storing computer readable instructions that, when executed, causea device to characterize structures below the surface at a surgical siteand determine the depth of the structures below the surface of thetissue.

In some aspects, a surgical image acquisition system may comprise aplurality of illumination sources wherein each illumination source isconfigured to emit light having a specified central wavelength, a lightsensor configured to receive a portion of the light reflected from atissue sample when illuminated by the one or more of the plurality ofillumination sources, and a computing system. The computing system maybe configured to receive data from the light sensor when the tissuesample is illuminated by each of the plurality of illumination sources,calculate structural data related to a characteristic of a structurewithin the tissue sample based on the data received by the light sensorwhen the tissue sample is illuminated by each of the illuminationsources, and transmit the structural data related to the characteristicof the structure to be received by a smart surgical device. In someaspects, the characteristic of the structure is a surface characteristicor a structure composition.

In one aspect, a surgical system may include multiple laser lightsources and may receive laser light reflected from a tissue. The lightreflected from the tissue may be used by the system to calculate surfacecharacteristics of components disposed within the tissue. Thecharacteristics of the components disposed within the tissue may includea composition of the components and/or a metric related to surfaceirregularities of the components.

In one aspect, the surgical system may transmit data related to thecomposition of the components and/or metrics related to surfaceirregularities of the components to a second instrument to be used onthe tissue to modify the control parameters of the second instrument.

In some aspects, the second device may be an advanced energy device andthe modifications of the control parameters may include a clamppressure, an operational power level, an operational frequency, and atransducer signal amplitude.

As disclosed above, blood vessels may be detected under the surface of asurgical site base on the Doppler shift in light reflected by the bloodcells moving within the blood vessels.

Laser Doppler flowmetry may be used to visualize and characterized aflow of particles moving relative to an effectively stationarybackground. Thus, laser light scattered by moving particles, such asblood cells, may have a different wavelength than that of the originalilluminating laser source. In contrast, laser light scattered by theeffectively stationary background (for example, the vascular tissue) mayhave the same wavelength of that of the original illuminating lasersource. The change in wavelength of the scattered light from the bloodcells may reflect both the direction of the flow of the blood cellsrelative to the laser source as well as the blood cell velocity. Aspreviously disclosed, FIGS. 156A-C illustrate the change in wavelengthof light scattered from blood cells that may be moving away from (FIG.156A) or towards (FIG. 156C) the laser light source.

In each of FIGS. 156A-C, the original illuminating light 2502 isdepicted having a relative central wavelength of 0. It may be observedfrom FIG. 156A that light scattered from blood cells moving away fromthe laser source 2504 has a wavelength shifted by some amount 2506 to agreater wavelength relative to that of the laser source (and is thus redshifted). It may also be observed from FIG. 154C that light scatteredfrom blood cells moving towards from the laser source 2508 has awavelength shifted by some amount 2510 to a shorter wavelength relativeto that of the laser source (and is thus blue shifted). The amount ofwavelength shift (for example 2506 or 2510) may be dependent on thevelocity of the motion of the blood cells. In some aspects, an amount ofa red shift (2506) of some blood cells may be about the same as theamount of blue shift (2510) of some other blood cells. Alternatively, anamount of a red shift (2506) of some blood cells may differ from theamount of blue shift (2510) of some other blood cells Thus, the velocityof the blood cells flowing away from the laser source as depicted inFIG. 154A may be less than the velocity of the blood cells flowingtowards the laser source as depicted in FIG. 156C based on the relativemagnitude of the wavelength shifts (2506 and 2510). In contrast, and asdepicted in FIG. 156B, light scattered from tissue not moving relativeto the laser light source (for example blood vessels 2512 ornon-vascular tissue 2514) may not demonstrate any change in wavelength.

As previously disclosed, FIG. 157 depicts an aspect of instrumentation2530 that may be used to detect a Doppler shift in laser light scatteredfrom portions of a tissue 2540. Light 2534 originating from a laser 2532may pass through a beam splitter 2544. Some portion of the laser light2536 may be transmitted by the beam splitter 2544 and may illuminatetissue 2540. Another portion of the laser light may be reflected 2546 bythe beam splitter 2544 to impinge on a detector 2550. The lightback-scattered 2542 by the tissue 2540 may be directed by the beamsplitter 2544 and also impinge on the detector 2550. The combination ofthe light 2534 originating from the laser 2532 with the lightback-scattered 2542 by the tissue 2540 may result in an interferencepattern detected by the detector 2550. The interference pattern receivedby the detector 2550 may include interference fringes resulting from thecombination of the light 2534 originating from the laser 2532 and theDoppler shifted (and thus wavelength shifted) light back-scattered 2452from the tissue 2540.

It may be recognized that back-scattered light 2542 from the tissue 2540may also include back scattered light from boundary layers within thetissue 2540 and/or wavelength-specific light absorption by materialwithin the tissue 2540. As a result, the interference pattern observedat the detector 2550 may incorporate interference fringe features fromthese additional optical effects and may therefore confound thecalculation of the Doppler shift unless properly analyzed.

It may be recognized that light reflected from the tissue may alsoinclude back scattered light from boundary layers within the tissueand/or wavelength-specific light absorption by material within thetissue. As a result, the interference pattern observed at the detectormay incorporate fringe features that may confound the calculation of theDoppler shift unless properly analyzed.

As previously disclosed, FIG. 158 depicts some of these additionaloptical effects. It is well known that light traveling through a firstoptical medium having a first refractive index, n1, may be reflected atan interface with a second optical medium having a second refractiveindex, n2. The light transmitted through the second optical medium willhave a transmission angle relative to the interface that differs fromthe angle of the incident light based on a difference between therefractive indices n1 and n2 (Snell's Law). FIG. 156 illustrates theeffect of Snell's Law on light impinging on the surface of amulti-component tissue 2150, as may be presented in a surgical field.The multi-component tissue 2150 may be composed of an outer tissue layer2152 having a refractive index n1 and a buried tissue, such as a bloodvessel having a vessel wall 2156. The blood vessel wall 2156 may becharacterized by a refractive index n2. Blood may flow within the lumenof the blood vessel 2160. In some aspects, it may be important during asurgical procedure to determine the position of the blood vessel 2160below the surface 2154 of the outer tissue layer 2152 and tocharacterize the blood flow using Doppler shift techniques.

An incident laser light 2170 a may be used to probe for the blood vessel2160 and may be directed on the top surface 2154 of the outer tissuelayer 2152. A portion 2172 of the incident laser light 2170 a may bereflected at the top surface 2154. Another portion 2170 b of theincident laser light 2170 a may penetrate the outer tissue layer 2152.The reflected portion 2172 at the top surface 2154 of the outer tissuelayer 2152 has the same path length of the incident light 2170 a, andtherefore has the same wavelength and phase of the incident light 2170a. However, the portion 2170 b of light transmitted into the outertissue layer 2152 will have a transmission angle that differs from theincidence angle of the light impinging on the tissue surface because theouter tissue layer 2152 has an index of refraction n1 that differs fromthe index of refraction of air.

If the portion of light transmitted through the outer tissue layer 2152impinges on a second tissue surface 2158, for example of the bloodvessel wall 2156, some portion 2174 a,b of light will be reflected backtowards the source of the incident light 2170 a. The light thusreflected 2174 a at the interface between the outer tissue layer 2152and the blood vessel wall 2156 will have the same wavelength as theincident light 2170 a, but will be phase shifted due to the change inthe light path length. Projecting the light reflected 2174 a,b from theinterface between the outer tissue layer 2152 and the blood vessel wall2156 along with the incident light on the sensor, will produce aninterference pattern based on the phase difference between the two lightsources.

Further, a portion of the incident light 2170 c may be transmittedthrough the blood vessel wall 2156 and penetrate into the blood vessellumen 2160. This portion of the incident light 2170 c may interact withthe moving blood cells in the blood vessel lumen 2160 and may bereflected back 2176 a-c towards the source of the impinging light havinga wavelength Doppler shifted according to the velocity of the bloodcells, as disclosed above. The Doppler shifted light reflected 2176 a-cfrom the moving blood cells may be projected along with the incidentlight on the sensor, resulting in an interference pattern having afringe pattern based on the wavelength difference between the two lightsources.

In FIG. 158 , a light path 2178 is presented of light impinging on thered blood cells in the blood vessel lumen 2160 if there are no changesin refractive index between the emitted light and the light reflected bythe moving blood cells. In this example, only a Doppler shift in thereflected light wavelength can be detected. However, the light reflectedby the blood cells (2176 a-c) may incorporate phase changes due to thevariation in the tissue refractive indices in addition to the wavelengthchanges due to the Doppler Effect.

Thus, it may be understood that if the light sensor receives theincident light, the light reflected from one or more tissue interfaces(2172, and 2174 a,b) and the Doppler shifted light from the blood cells(2176 a-c), the interference pattern thus produced on the light sensormay include the effects due to the Doppler shift (change in wavelength)as well as the effects due to the change in refractive index within thetissue (change in phase). As a result, a Doppler analysis of the lightreflected by the tissue sample may produce erroneous results if theeffects due to changes in the refractive index within the sample are notcompensated for.

As previously disclosed, FIG. 159 illustrates an example of the effectson a Doppler analysis of light that impinge 2250 on a tissue sample todetermine the depth and location of an underlying blood vessel. If thereis no intervening tissue between the blood vessel and the tissuesurface, the interference pattern detected at the sensor may be dueprimarily to the change in wavelength reflected from the moving bloodcells. As a result, a spectrum 2252 derived from the interferencepattern may generally reflect only the Doppler shift of the blood cells.However, if there is intervening tissue between the blood vessel and thetissue surface, the interference pattern detected at the sensor may bedue to a combination of the change in wavelength reflected from themoving blood cells and the phase shift due to the refractive index ofthe intervening tissue. A spectrum 2254 derived from such aninterference pattern, may result in the calculation of the Doppler shiftthat is confounded due to the additional phase change in the reflectedlight. In some aspects, if information regarding the characteristics(thickness and refractive index) of the intervening tissue is known, theresulting spectrum 2256 may be corrected to provide a more accuratecalculation of the change in wavelength.

It may be recognized that the phase shift in the reflected light from atissue may provide additional information regarding underlying tissuestructures, regardless of Doppler effects.

FIG. 167 illustrates that the location and characteristics ofnon-vascular structures may be determined based on the phase differencebetween the incident light 2372 and the light reflected from the deeptissue structures (2374, 2376, 2378). As noted above, the penetrationdepth of light impinging on a tissue is dependent on the wavelength ofthe impinging illumination. Red laser light (having a wavelength in therange of about 635 nm to about 660 nm) may penetrate the tissue to adepth of about 1 mm. Green laser light (having a wavelength in the rangeof about 520 nm to about 532 nm) may penetrate the tissue to a depth ofabout 2-3 mm. Blue laser light (having a wavelength in the range ofabout 405 nm to about 445 nm) may penetrate the tissue to a depth ofabout 4 mm or greater. In one aspect, an interface 2381 a between twotissues differing in refractive index that is located less than or about1 mm below a tissue surface 2380 may reflect 2374 red, green, or bluelaser light. The phase of the reflected light 2374 may be compared tothe incident light 2372 and thus the difference in the refractive indexof the tissues at the interface 2381 a may be determined. In anotheraspect, an interface 2381 b between two tissues differing in refractiveindex that is located between 2 and 3 mm 2381 b below a tissue surface2380 may reflect 2376 green or blue laser light, but not red light. Thephase of the reflected light 2376 may be compared to the incident light2372 and thus the difference in the refractive index of the tissues atthe interface 2381 b may be determined. In yet another aspect, aninterface 2381 c between two tissues differing in refractive index thatis located between 3 and 4 mm 2381 c below a tissue surface 2380 mayreflect 2378 only blue laser light, but not red or green light. Thephase of the reflected light 2378 may be compared to the incident light2372 and thus the difference in the refractive index of the tissues atthe interface 2381 c may be determined.

A phase interference measure of a tissue illuminated by light havingdifferent wavelengths may therefore provide information regarding therelative indices of refraction of the reflecting tissue as well as thedepth of the tissue. The indices of refraction of the tissue may beassessed using the multiple laser sources and their intensity, andthereby relative indices of refraction may be calculated for the tissue.It is recognized that different tissues may have different refractiveindices. For example, the refractive index may be related to therelative composition of collagen and elastin in a tissue or the amountof hydration of the tissue. Therefore, a technique to measure relativetissue index of refraction may result in the identification of acomposition of the tissue.

In some aspects, smart surgical instruments include algorithms todetermine parameters associated with the function of the instruments.One non-limiting example of such parameters may be the pressure of ananvil against a tissue for a smart stapling device. The amount ofpressure of an anvil against a tissue may depend on the type andcomposition of the tissue. For example, less pressure may be required tostaple a highly compressive tissue, while a greater amount of pressuremay be required to stable a more non-compressive tissue. Anothernon-limiting example of a parameter associated with a smart surgicaldevice may include a rate of firing of an i-beam knife to cut thetissue. For example, a stiff tissue may require more force and a slowercutting rate than a less stiff tissue. Another non-limiting example ofsuch parameters may be the amount of current provided to an electrode ina smart cauterizing or RF sealing device. Tissue composition, such aspercent tissue hydration, may determine an amount of current necessaryto heat seal the tissue. Yet another non-limiting example of suchparameters may be the amount of power provided to an ultrasonictransducer of a smart ultrasound cutting device or the driving frequencyof the cutting device. A stiff tissue may require more power forcutting, and contact of the ultrasonic cutting tool with a stiff tissuemay shift the resonance frequency of the cutter.

It may be recognized that a tissue visualization system that canidentify tissue type and depth may provide such data to one or moresmart surgical devices. The identification and location data may then beused by the smart surgical devices to adjust one or more of theiroperating parameters thereby allowing them to optimize theirmanipulation of the tissue. It may be understood that an optical methodto characterize a type of tissue may permit automation of the operatingparameters of the smart surgical devices. Such automation of theoperation of smart surgical instruments may be preferable to relying onhuman estimation to determine the operational parameters of theinstruments.

In one aspect, Optical Coherence Tomography (OCT) is a technique thatcan visual subsurface tissue structures based on the phase differencebetween an illuminating light source, and light reflected fromstructures located within the tissue. FIG. 168 depicts schematically oneexample of instrumentation 2470 for Optical Coherence Tomography. InFIG. 168 , a laser source 2472 may emit light 2482 according to anyoptical wavelength of interest (red, green, blue, infrared, orultraviolet). The light 2482 may be directed to a beam splitter 2486.The beam splitter 2486 directs one portion of the light 2488 to a tissuesample 2480. The beam splitter 2486 may also direct a portion of thelight 2492 to a stationary reference mirror 2494. The light reflectedfrom the tissue sample 2480 and from the stationary mirror 2494 may berecombined 2498 at the beam splitter 2486 and directed to a detector2496. The phase difference between the light from the reference mirror2494 and from the tissue sample 2480 may be detected at the detector2496 as an interference pattern. Appropriate computing devices may thencalculate phase information from the interference pattern. Additionalcomputation may then provide information regarding structures below thesurface of the tissue sample. Additional depth information may also beobtained by comparing the interference patterns generated from thesample when illuminated at different wavelengths of laser light.

As disclosed above, depth information regarding subsurface tissuestructures may be ascertained from a combination of laser lightwavelength and the phase of light reflected from a deep tissuestructure. Additionally, local tissue surface inhomogeneity may beascertained by comparing the phase as well as amplitude difference oflight reflected from different portions of the same sub-surface tissues.Measurements of a difference in the tissue surface properties at adefined location compared to those at a neighboring location may beindicative of adhesions, disorganization of the tissue layers,infection, or a neoplasm in the tissue being probed.

FIG. 169 illustrates this effect. The surface characteristics of atissue determine the angle of reflection of light impinging on thesurface. A smooth surface 2551 a reflects the light essentially with thesame spread 2544 as the light impinging on the surface 2542 (specularreflection). Consequently, the amount of light received by a lightdetector having a known fixed aperture may effectively receive theentire amount of light reflected 2544 from the smooth surface 2551 a.However, increased surface roughness at a tissue surface may result inan increase spread in the reflected light with respect to the incidentlight (diffuse reflection).

Some amount of the reflected light 2546 from a tissue surface havingsome amount of surface irregularities 2551 b will fall outside the fixedaperture of the light detector due to the increased spread of thereflected light 2546. As a result, the light detector will detect lesslight (shown in FIG. 169 as a decrease in the amplitude of the reflectedlight signal 2546). It may be understood that the amount of reflectedlight spread will increase as the surface roughness of a tissueincreases. Thus, as depicted in FIG. 169 , the amplitude of lightreflected 2548 from a surface 2551 c having significant surfaceroughness may have a smaller amplitude than the light reflected 2544from a smooth surface 2551 a, or light reflected 2546 form a surfacehaving only a moderate amount of surface roughness 2551 b. Therefore, insome aspects, a single laser source may be used to investigate thequality of a tissue surface or subsurface by comparing the opticalproperties of reflected light from the tissue with the opticalproperties of reflected light from adjacent surfaces.

In other aspects, light from multiple laser sources (for example, lasersemitting light having different central wavelengths) may be usedsequentially to probe tissue surface characteristics at a variety ofdepths below the surface 2550. As disclosed above (with reference toFIG. 167 ), the absorbance profile of a laser light in a tissue isdependent on the central wavelength of the laser light. Laser lighthaving a shorter (more blue) central wavelength can penetrate tissuedeeper than laser light having a longer (more red) central wavelength.Therefore, measurements related to light diffuse reflection made atdifferent light wavelengths can indicate both an amount of surfaceroughness as well as the depth of the surface being measured.

FIG. 170 illustrates one method of displaying image processing datarelated to a combination of tissue visualization modalities. Data usedin the display may be derived from image phase data related to tissuelayer composition, image intensity (amplitude) data related to tissuesurface features, and image wavelength data related to tissue mobility(such as blood cell transport) as well as tissue depth. As one example,light emitted by a laser in the blue optical region 2562 may impinge onblood flowing at a depth of about 4 mm below the surface of the tissue.The reflected light 2564 may be red shifted due to the Doppler effect ofthe blood flow. As a result, information may be obtained regarding theexistence of a blood vessel and its depth below the surface.

In another example, a layer of tissue may lie at a depth of about 2-3 mmbelow the surface of the surgical site. This tissue may include surfaceirregularities indicative of scarring or other pathologies. Emitted redlight 2572 may not penetrate to the 2-3 mm depth, so consequently, thereflected red light 2580 may have about the same amplitude of theemitted red light 2572 because it is unable to probe structures morethan 1 mm below the top surface of the surgical site. However, greenlight reflected from the tissue 2578 may reveal the existence of thesurface irregularities at that depth in that the amplitude of thereflected green light 2578 may be less than the amplitude of the emittedgreen light 2570. Similarly, blue light reflected from the tissue 2574may reveal the existence of the surface irregularities at that depth inthat the amplitude of the reflected blue light 2574 may be less than theamplitude of the emitted blue light 2562. In one example of an imageprocessing step, the image 2582 may be smoothed using a moving windowfilter 2584 to reduce inter-pixel noise as well as reduce small localtissue anomalies 2586 that may hide more important features 2588.

FIGS. 171A-C illustrate several aspects of displays that may be providedto a surgeon for a visual identification of surface and sub-surfacestructures of a tissue in a surgical site. FIG. 171A may represent asurface map of the surgical site with color coding to indicatestructures located at varying depths below the surface of the surgicalsite. FIG. 171B depicts an example of one of several horizontal slicesthrough the tissue at varying depths, which may be color coded toindicate depth and further include data associated with differences intissue surface anomalies (for example, as displayed in a 3D bar graph).FIG. 171C depicts yet another visual display in which surfaceirregularities as well as Doppler shift flowmetry data may indicatesub-surface vascular structures as well as tissue surfacecharacteristics.

FIG. 172 is a flow chart 2950 of a method for providing informationrelated to a characteristic of a tissue to a smart surgical instrument.An image acquisition system may illuminate 2960 a tissue with a firstlight beam having a first central frequency and receive 2962 a firstreflected light from the tissue illuminated by the first light beam. Theimage acquisition system may then calculate 2964 a first tissue surfacecharacteristic at a first depth based on the first emitted light beamand the first reflected light from the tissue. The image acquisitionsystem may then illuminate 2966 the tissue with a second light beamhaving a second central frequency and receive 2968 a second reflectedlight from the tissue illuminated by the second light beam. The imageacquisition system may then calculate 2970 a second tissue surfacecharacteristic at a second depth based on the second emitted light beamand the second reflected light from the tissue. Tissue features that mayinclude a tissue type, a tissue composition, and a tissue surfaceroughness metric may be determined from the first central lightfrequency, the second central light frequency, the first reflected lightfrom the tissue, and the second reflected light from the tissue. Thetissue characteristic may be used to calculate 2972 one or moreparameters related to the function of a smart surgical instrument suchas jaw pressure, power to effect tissue cauterization, or currentamplitude and/or frequency to drive a piezoelectric actuator to cut atissue. In some additional examples, the parameter may be transmitted2974 either directly or indirectly to the smart surgical instrumentwhich may modify its operating characteristics in response to the tissuebeing manipulated.

Multifocal Minimally Invasive Camera

In a minimally invasive procedure, e.g., laparoscopic, a surgeon mayvisualize the surgical site using imaging instruments including a lightsource and a camera. The imaging instruments may allow the surgeon tovisualize the end effector of a surgical device during the procedure.However, the surgeon may need to visualize tissue away from the endeffector to prevent unintended damage during the surgery. Such distanttissue may lie outside the field of view of the camera system whenfocused on the end effector. The imaging instrument may be moved inorder to change the field of view of the camera, but it may be difficultto return the camera system back to its original position after beingmoved.

The surgeon may attempt to move the imaging system within the surgicalsite to visualize different portions of the site during the procedure.Repositioning of the imaging system is time consuming and the surgeon isnot guaranteed to visualize the same field of view of the surgical sitewhen the imaging system is returned to its original location.

It is therefore desirable to have a medical imaging visualization systemthat can provide multiple fields of view of the surgical site withoutthe need to reposition the visualization system. Medical imaging devicesinclude, without limitation, laparoscopes, endoscopes, thoracoscopes,and the like, as described herein. In some aspects, a single displaysystem may display each of the multiple fields of view of the surgicalsite at about the same time. The display of each of the multiple fieldsof view may be independently updated depending on a display controlsystem composed of one or more hardware modules, one or more softwaremodules, one or more firmware modules, or any combination orcombinations thereof.

Some aspects of the present disclosure further provide for a controlcircuit configured to control the illumination of a surgical site usingone or more illumination sources such as laser light sources and toreceive imaging data from one or more image sensors. In some aspects,the control circuit may be configured to control the operation of one ormore light sensor modules to adjust a field of view. In some aspects,the present disclosure provides for a non-transitory computer readablemedium storing computer readable instructions that, when executed, causea device to adjust one or more components of the one or more lightsensor modules and to process an image from each of the one or morelight sensor modules.

An aspect of a minimally invasive image acquisition system may comprisea plurality of illumination sources wherein each illumination source isconfigured to emit light having a specified central wavelength, a firstlight sensing element having a first field of view and configured toreceive illumination reflected from a first portion of the surgical sitewhen the first portion of the surgical site is illuminated by at leastone of the plurality of illumination sources, a second light sensingelement having a second field of view and configured to receiveillumination reflected from a second portion of the surgical site whenthe second portion of the surgical site is illuminated by at least oneof the plurality of illumination sources, wherein the second field ofview overlaps at least a portion of the first field of view; and acomputing system.

The computing system may be configured to receive data from the firstlight sensing element, receive data from the second light sensingelement, compute imaging data based on the data received from the firstlight sensing element and the data received from the second lightsensing element, and transmit the imaging data for receipt by a displaysystem.

A variety of surgical visualization systems have been disclosed above.Such systems provide for visualizing tissue and sub-tissue structuresthat may be encountered during one or more surgical procedures.Non-limiting examples of such systems may include: systems to determinethe location and depth of subsurface vascular tissue such as veins andarteries; systems to determine an amount of blood flowing through thesubsurface vascular tissue; systems to determine the depth ofnon-vascular tissue structures; systems to characterize the compositionof such non-vascular tissue structures; and systems to characterize oneor more surface characteristics of such tissue structures.

It may be recognized that a single surgical visualization system mayincorporate components of any one or more of these visualizationmodalities. FIGS. 152A-D depict some examples of such a surgicalvisualization system 2108.

As disclosed above, in one non-limiting aspect, a surgical visualizationsystem 2108 may include an imaging control unit 2002 and a hand unit2020. The hand unit 2020 may include a body 2021, a camera scope cable2015 attached to the body 2021, and an elongated camera probe 2024. Theelongated camera probe 2024 may also terminate at its distal end with atleast one window. In some non-limiting examples, a light sensor 2030 maybe incorporated in the hand unit 2020, for example either in the body ofthe hand unit 2032 b, or at a distal end 2032 a of the elongated cameraprobe, as depicted in FIG. 152C. The light sensor 2030 may be fabricatedusing a CMOS sensor array or a CCD sensor array. As illustrated in FIG.153C, a typical CMOS or CCD sensor array may generate an RGB(red-green-blue) image from light impinging on a mosaic of sensorelements, each sensor element having one of a red, green, or blueoptical filter.

Alternatively, the illumination of the surgical site may be cycled amongvisible illumination sources as depicted in FIG. 160D. In some example,the illumination sources may include any one or more of a red laser 2360a, a green laser 2360 b, or a blue laser 2360 c. In some non-limitingexamples, a red laser 2360 a light source may source illumination havinga peak wavelength that may range between 635 nm and 660 nm, inclusive.Non-limiting examples of a red laser peak wavelength may include about635 nm, about 640 nm, about 645 nm, about 650 nm, about 655 nm, about660 nm, or any value or range of values therebetween. In somenon-limiting examples, a green laser 2360 b light source may sourceillumination having a peak wavelength that may range between 520 nm and532 nm, inclusive. Non-limiting examples of a red laser peak wavelengthmay include about 520 nm, about 522 nm, about 524 nm, about 526 nm,about 528 nm, about 530 nm, about 532 nm, or any value or range ofvalues therebetween. In some non-limiting examples, the blue laser 2360c light source may source illumination having a peak wavelength that mayrange between 405 nm and 445 nm, inclusive. Non-limiting examples of ablue laser peak wavelength may include about 405 nm, about 410 nm, about415 nm, about 420 nm, about 425 nm, about 430 nm, about 435 nm, about440 nm, about 445 nm, or any value or range of values therebetween.

Additionally, illumination of the surgical site may be cycled to includenon-visible illumination sources that may supply infrared or ultravioletillumination. In some non-limiting examples, an infrared laser lightsource may source illumination having a peak wavelength that may rangebetween 750 nm and 3000 nm, inclusive. Non-limiting examples of aninfrared laser peak wavelength may include about 750 nm, about 1000 nm,about 1250 nm, about 1500 nm, about 1750 nm, about 2000 nm, about 2250nm, about 2500 nm, about 2750 nm, 3000 nm, or any value or range ofvalues therebetween. In some non-limiting examples, an ultraviolet laserlight source may source illumination having a peak wavelength that mayrange between 200 nm and 360 nm, inclusive. Non-limiting examples of anultraviolet laser peak wavelength may include about 200 nm, about 220nm, about 240 nm, about 260 nm, about 280 nm, about 300 nm, about 320nm, about 340 nm, about 360 nm, or any value or range of valuestherebetween.

The outputs of the sensor array under the different illuminationwavelengths may be combined to form the RGB image, for example, if theillumination cycle time is sufficiently fast and the laser light is inthe visible range. FIGS. 173A and 173B illustrate a multi-pixel lightsensor receiving by light reflected by a tissue illuminated, forexample, by sequential exposure to red, green, blue, infrared, (FIG.173A) or red, green, blue, and ultraviolet laser light sources (FIG.173B).

FIG. 174A depicts the distal end of a flexible elongated camera probe2120 having a flexible camera probe shaft 2122 and a single light sensormodule 2124 disposed at the distal end 2123 of the flexible camera probeshaft 2122. In some non-limiting examples, the flexible camera probeshaft 2122 may have an outer diameter of about 5 mm. The outer diameterof the flexible camera probe shaft 2122 may depend on geometric factorsthat may include, without limitation, the amount of allowable bend inthe shaft at the distal end 2123. As depicted in FIG. 174A, the distalend 2123 of the flexible camera probe shaft 2122 may bend about 90° withrespect to a longitudinal axis of an un-bent portion of the flexiblecamera probe shaft 2122 located at a proximal end of the elongatedcamera probe 2120. It may be recognized that the distal end 2123 of theflexible camera probe shaft 2122 may bend any appropriate amount as maybe required for its function. Thus, as non-limiting examples, the distalend 2123 of the flexible camera probe shaft 2122 may bend any amountbetween about 0° and about 90°. Non-limiting examples of the bend angleof the distal end 2123 of the flexible camera probe shaft 2122 mayinclude about 0°, about 10°, about 20°, about 30°, about 40°, about 50°,about 60°, about 70°, about 80°, about 90°, or any value or range ofvalues therebetween. In some examples, the bend angle of the distal end2123 of the flexible camera probe shaft 2122 may be set by a surgeon orother health care professional prior to or during a surgical procedure.In some other example, the bend angle of the distal end 2123 of theflexible camera probe shaft 2122 may be a fixed angle set at amanufacturing site.

The single light sensor module 2124 may receive light reflected from thetissue when illuminated by light emitted by one or more illuminationsources 2126 disposed at the distal end of the elongated camera probe.In some examples, the light sensor module 2124 may be a 4 mm sensormodule such as 4 mm mount 2136 b, as depicted in FIG. 152D. It may berecognized that the light sensor module 2124 may have any appropriatesize for its intended function. Thus, the light sensor module 2124 mayinclude a 5.5 mm mount 2136 a, a 2.7 mm mount 2136 c, or a 2 mm mount2136 d as depicted in FIG. 152D.

It may be recognized that the one or more illumination sources 2126 mayinclude any number of illumination sources 2126 including, withoutlimitation, one illumination source, two illumination sources, threeillumination sources, four illumination sources, or more than fourillumination sources. It may be further understood that eachillumination source may source illumination having any centralwavelength including a central red illumination wavelength, a centralgreen illumination wavelength, a central blue illumination wavelength, acentral infrared illumination wavelength, a central ultravioletillumination wavelength, or any other wavelength. In some examples, theone or more illumination sources 2126 may include a white light source,which may illuminate tissue with light having wavelengths that may spanthe range of optical white light from about 390 nm to about 700 nm.

FIG. 174B depicts the distal end 2133 of an alternative elongated cameraprobe 2130 having multiple light sensor modules, for example the twolight sensor modules 2134 a,b, each disposed at the distal end 2133 ofthe elongated camera probe 2130. In some non-limiting examples, thealternative elongated camera probe 2130 may have an outer diameter ofabout 7 mm. In some examples, the light sensor modules 2134 a,b may eachcomprise a 4mm sensor module, similar to light sensor module 2124 inFIG. 174A. Alternatively, each of the light sensor modules 2134 a,b maycomprise a 5.5 mm light sensor module, a 2.7 mm light sensor module, ora 2 mm light sensor module as depicted in FIG. 152D. In some examples,both light sensor modules 2134 a,b may have the same size. In someexamples, the light sensor modules 2134 a,b may have different sizes. Asone non-limiting example, an alternative elongated camera probe 2130 mayhave a first 4 mm light sensor and two additional 2 mm light sensors. Insome aspects, a visualization system may combine the optical outputsfrom the multiple light sensor modules 2134 a,b to form a 3D or quasi-3Dimage of the surgical site. In some other aspects, the outputs of themultiple light sensor modules 2134 a,b may be combined in such a manneras to enhance the optical resolution of the surgical site, which may notbe otherwise practical with only a single light sensor module.

Each of the multiple light sensor modules 2134 a,b may receive lightreflected from the tissue when illuminated by light emitted by one ormore illumination sources 2136 a,b disposed at the distal end 2133 ofthe alternative elongated camera probe 2130. In some non-limitingexamples, the light emitted by all of the illumination sources 2136 a,bmay be derived from the same light source (such as a laser). In othernon-limiting examples, the illumination sources 2136 a surrounding afirst light sensor module 2134 a may emit light at a first wavelengthand the illumination sources 2136 b surrounding a second light sensormodule 2134 b may emit light at a second wavelength. It may be furtherunderstood that each illumination source 2136 a,b may sourceillumination having any central wavelength including a central redillumination wavelength, a central green illumination wavelength, acentral blue illumination wavelength, a central infrared illuminationwavelength, a central ultraviolet illumination wavelength, or any otherwavelength. In some examples, the one or more illumination sources 2136a,b may include a white light source, which may illuminate tissue withlight having wavelengths that may span the range of optical white lightfrom about 390 nm to about 700 nm.

In some additional aspects, the distal end 2133 of the alternativeelongated camera probe 2130 may include one or more working channels2138. Such working channels 2138 may be in fluid communication with anaspiration port of a device to aspirate material from the surgical site,thereby permitting the removal of material that may potentially obscurethe field of view of the light sensor modules 2134 a,b. Alternatively,such working channels 2138 may be in fluid communication with an fluidsource port of a device to provide a fluid to the surgical site, toflush debris or material away from the surgical site. Such fluids may beused to clear material from the field of view of the light sensormodules 2134 a,b.

FIG. 174C depicts a perspective view of an aspect of a monolithic sensor2160 having a plurality of pixel arrays for producing a threedimensional image in accordance with the teachings and principles of thedisclosure. Such an implementation may be desirable for threedimensional image capture, wherein the two pixel arrays 2162 and 2164may be offset during use. In another implementation, a first pixel array2162 and a second pixel array 2164 may be dedicated to receiving apredetermined range of wave lengths of electromagnetic radiation,wherein the first pixel array 2162 is dedicated to a different range ofwave length electromagnetic radiation than the second pixel array 2164.

Additional disclosures regarding a dual sensor array may be found inU.S. Patent Application Publication No. 2014/0267655, entitled SUPERRESOLUTION AND COLOR MOTION ARTIFACT CORRECTION IN A PULSED COLORIMAGING SYSTEM, filed on Mar. 14, 2014, which issued on May 2, 2017 asU.S. Pat. No. 9,641,815, the contents thereof being incorporated byreference herein in its entirety and for all purposes.

In some aspects, a light sensor module may comprise a multi-pixel lightsensor such as a CMOS array in addition to one or more additionaloptical elements such as a lens, a reticle, and a filter.

In some alternative aspects, the one or more light sensors may belocated within the body 2021 of the hand unit 2020. Light reflected fromthe tissue may be acquired at a light receiving surface of one or moreoptical fibers at the distal end of the elongated camera probe 2024. Theone or more optical fibers may conduct the light from the distal end ofthe elongated camera probe 2024 to the one or more light sensors, or toadditional optical elements housed in the body of the hand unit 2020 orin the imaging control unit 2002. The additional optical elements mayinclude, without limitation, one or more dichroic mirrors, one or morereference mirrors, one or more moving mirrors, and one or more beamsplitters and/or combiners, and one or more optical shutters. In suchalternative aspects, the light sensor module may include any one or moreof a lens, a reticle and a filter, disposed at the distal end of theelongated camera probe 2024.

Images obtained from each of the multiple light sensors for example 2134a,b may be combined or processed in several different manners, either incombination or separately, and then displayed in a manner to allow asurgeon to visualize different aspects of the surgical site.

In one non-limiting example, each light sensor may have an independentfield of view. In some additional examples, the field of view of a firstlight sensor may partially or completely overlap the field of view of asecond light sensor.

As disclosed above, an imaging system may include a hand unit 2020having an elongated camera probe 2024 with one or more light sensormodules 2124, 2134 a,b disposed at its distal end 2123, 2133. As anexample, the elongated camera probe 2024 may have two light sensormodules 2134 a,b, although it may be recognized that there may be three,four, five, or more light sensor modules at the distal end of theelongated camera probe 2024. Although FIGS. 175 and 176A-D depictexamples of the distal end of an elongated camera probe having two lightsensor modules, it may be recognized that the description of theoperation of the light sensor modules is not limited to solely two lightsensor modules. As depicted in FIGS. 175, and 46A-D, the light sensormodules may include an image sensor, such as a CCD or CMOS sensor thatmay be composed of an array of light sensing elements (pixels). Thelight sensor modules may also include additional optical elements, suchas lenses. Each lens may be adapted to provide a field of view for thelight sensor of the respective light sensor module.

FIG. 175 depicts a generalized view of a distal end 2143 of an elongatedcamera probe having multiple light sensor modules 2144 a,b. Each lightsensor module 2144 a,b may be composed of a CCD or CMOS sensor and oneor more optical elements such as filters, lenses, shutters, and similar.In some aspects, the components of the light sensor modules 2144 a,b maybe fixed within the elongated camera probe. In some other aspects, oneor more of the components of the light sensor modules 2144 a,b may beadjustable. For example, the CCD or CMOS sensor of a light sensor module2144 a,b may be mounted on a movable mount to permit automatedadjustment of the center 2145 a,b of a field of view 2147 a,b of the CCDor CMOS sensor. In some other aspects, the CCD or CMOS sensor may befixed, but a lens in each light sensor modules 2144 a,b may beadjustable to change the focus. In some aspects, the light sensormodules 2144 a,b may include adjustable irises to permit changes in thevisual aperture of the sensor modules 2144 a,b.

As depicted in FIG. 175 , each of the sensor modules 2144 a,b may have afield of view 2147 a,b having an acceptance angle. As depicted in FIG.175 , the acceptance angle for each sensor modules 2144 a,b may have anacceptance angle of greater than 90°. In some examples, the acceptanceangle may be about 100°. In some examples, the acceptance angle may beabout 120°. In some examples, if the sensor modules 2144 a,b have anacceptance angle of greater than 90° (for example, 100°), the fields ofview 2147 a and 2147 b may form an overlap region 2150 a,b. In someaspects, an optical field of view having an acceptance angle of 100° orgreater may be called a “fish-eyed” field of view. A visualizationsystem control system associated with such an elongated camera probe mayinclude computer readable instructions that may permit the display ofthe overlap region 2150 a,b in such a manner so that the extremecurvature of the overlapping fish-eyed fields of view is corrected, anda sharpened and flattened image may be displayed. In FIG. 175 , theoverlap region 2150 a may represent a region wherein the overlappingfields of view 2147 a,b of the sensor modules 2144 a,b have theirrespective centers 2145 a,b directed in a forward direction. However, ifany one or more components of the sensor modules 2144 a,b is adjustable,it may be recognized that the overlap region 2150 b may be directed toany attainable angle within the fields of view 2147 a,b of the sensormodules 2144 a,b.

FIGS. 176A-D depict a variety of examples of an elongated light probehaving two light sensor modules 2144 a,b with a variety of fields ofview. The elongated light probe may be directed to visualize a surface2152 of a surgical site.

In FIG. 176A, the first light sensor module 2144 a has a first sensorfield of view 2147 a of a tissue surface 2154 a, and the second lightsensor module 2144 b has a second sensor field of view 2147 b of atissue surface 2154 b. As depicted in FIG. 176A, the first field of view2147 a and the second field of view 2147 b have approximately the sameangle of view. Additionally, the first sensor field of view 2147 a isadjacent to but does not overlap the second sensor field of view 2147 b.The image received by the first light sensor module 2144 a may bedisplayed separately from the image received by the second light sensormodule 2144 b, or the images may be combined to form a single image. Insome non-limiting examples, the angle of view of a lens associated withthe first light sensor module 2144 a and the angle of view of a lensassociated with the second light sensor module 2144 b may be somewhatnarrow, and image distortion may not be great at the periphery of theirrespective images. Therefore, the images may be easily combined edge toedge.

As depicted in FIG. 176B, the first field of view 2147 a and the secondfield of view 2147 b have approximately the same angular field of view,and the first sensor field of view 2147 a overlaps completely the secondsensor field of view 2147 b. This may result in a first sensor field ofview 2147 a of a tissue surface 2154 a being identical to the view of atissue surface 2154 b as obtained by the second light sensor module 2144b from the second sensor field 2147 b of view. This configuration may beuseful for applications in which the image from the first light sensormodule 2144 a may be processed differently than the image from thesecond light sensor module 2144 b. The information in the first imagemay complement the information in the second image and refer to the sameportion of tissue.

As depicted in FIG. 176C, the first field of view 2147 a and the secondfield of view 2147 b have approximately the same angular field of view,and the first sensor field of view 2147 a partially overlaps the secondsensor field of view 2147 b. In some non-limiting examples, a lensassociated with the first light sensor module 2144 a and a lensassociated with the second light sensor module 2144 b may be wide anglelenses. These lenses may permit the visualization of a wider field ofview than that depicted in FIG. 176A. Wide angle lenses are known tohave significant optical distortion at their periphery. Appropriateimage processing of the images obtained by the first light sensor module2144 a and the second light sensor module 2144 b may permit theformation of a combined image in which the central portion of thecombined image is corrected for any distortion induced by either thefirst lens or the second lens. It may be understood that a portion ofthe first sensor field of view 2147 a of a tissue surface 2154 a maythus have some distortion due to the wide angle nature of a lensassociated with the first light sensor module 2144 a and a portion ofthe second sensor field of view 2147 b of a tissue surface 2154 b maythus have some distortion due to the wide angle nature of a lensassociated with the second light sensor module 2144 b. However, aportion of the tissue viewed in the overlap region 2150′ of the twolight sensor modules 2144 a,b may be corrected for any distortioninduced by either of the light sensor modules 2144 a,b. Theconfiguration depicted in FIG. 176C may be useful for applications inwhich it is desired to have a wide field of view of the tissue around aportion of a surgical instrument during a surgical procedure. In someexamples, lenses associated with each light sensor module 2144 a,b maybe independently controllable, thereby controlling the location of theoverlap region 2150′ of view within the combined image.

As depicted in FIG. 176D, the first light sensor module 2144 a may havea first angular field of view 2147 a that is wider than the secondangular field of view 2147 b of the second light sensor module 2144 b.In some non-limiting examples, the second sensor field of view 2147 bmay be totally disposed within the first sensor field of view 2147 a. Inalternative examples, the second sensor field of view may lie outside ofor tangent to the wide angle field of view 2147 a of the first sensor2144 a. A display system that may use the configuration depicted in FIG.176D may display a wide angle portion of tissue 2154 a imaged by thefirst sensor module 2144 a along with a magnified second portion oftissue 2154 b imaged by the second sensor module 2144 b and located inan overlap region 2150″ of the first field of view 2147 a and the secondfield of view 2147 b. This configuration may be useful to present asurgeon with a close-up image of tissue proximate to a surgicalinstrument (for example, imbedded in the second portion of tissue 2154b) and a wide-field image of the tissue surrounding the immediatevicinity of the medical instrument (for example, the proximal firstportion of tissue 2154 a). In some non-limiting examples, the imagepresented by the narrower second field of view 2147 b of the secondlight sensor module 2144 b may be a surface image of the surgical site.In some additional examples, the image presented in the first wide fieldview 2147 a of the first light sensor module 2144 a may include adisplay based on a hyperspectral analysis of the tissue visualized inthe wide field view.

FIGS. 177A-C illustrate an example of the use of an imaging systemincorporating the features disclosed in FIG. 176D. FIG. 177A illustratesschematically a proximal view 2170 at the distal end of the elongatedcamera probe depicting the light sensor arrays 2172 a,b of the two lightsensor modules 2174 a,b. A first light sensor module 2174 a may includea wide angle lens, and the second light sensor module 2174 b may includea narrow angle lens. In some aspects, the second light sensor module2174 b may have a narrow aperture lens. In other aspects, the secondlight sensor module 2174 b may have a magnifying lens. The tissue may beilluminated by the illumination sources disposed at the distal end ofthe elongated camera probe. The light sensor arrays 2172′ (either lightsensor array 2172 a or 2172 b, or both 2172 a and 2172 b) may receivethe light reflected from the tissue upon illumination. The tissue may beilluminated by light from a red laser source, a green laser source, ablue laser source, an infrared laser source, and/or an ultraviolet lasersource. In some aspects, the light sensor arrays 2172′ may sequentiallyreceive the red laser light 2175 a, green laser light 2175 b, blue laserlight 2175 c, infrared laser light 2175 d, and the ultra-violet laserlight 2175 e. The tissue may be illuminated by any combination of suchlaser sources simultaneously, as depicted in FIGS. 153E and 153F.Alternatively, the illuminating light may be cycled among anycombination of such laser sources, as depicted for example in FIGS.153D, and FIGS. 173A and 173B.

FIG. 177B schematically depicts a portion of lung tissue 2180 which maycontain a tumor 2182. The tumor 2182 may be in communication with bloodvessels including one or more veins 2184 and/or arteries 2186. In somesurgical procedures, the blood vessels (veins 2184 and arteries 2186)associated with the tumor 2182 may require resection and/orcauterization prior to the removal of the tumor.

FIG. 177C illustrates the use of a dual imaging system as disclosedabove with respect to FIG. 177A. The first light sensor module 2174 amay acquire a wide angle image of the tissue surrounding a blood vessel2187 to be severed with a surgical knife 2190. The wide angle image maypermit the surgeon to verify the blood vessel to be severed 2187. Inaddition, the second light sensor module 2174 b may acquire a narrowangle image of the specific blood vessel 2187 to be manipulated. Thenarrow angle image may show the surgeon the progress of the manipulationof the blood vessel 2187. In this manner, the surgeon is presented withthe image of the vascular tissue to be manipulated as well as itsenvirons to assure that the correct blood vessel is being manipulated.

FIGS. 178A and 178B depict another example of the use of a dual imagingsystem. FIG. 178A depicts a primary surgical display providing an imageof a section of a surgical site. The primary surgical display may depicta wide view image 2800 of a section of intestine 2802 along with itsvasculature 2804. The wide view image 2800 may include a portion of thesurgical field 2809 that may be separately displayed as a magnified view2810 in a secondary surgical display (FIG. 178B). As disclosed abovewith respect to surgery to remove a tumor from a lung (FIGS. 177A-C), itmay be necessary to dissect blood vessels supplying a tumor 2806 beforeremoving the cancerous tissue. The vasculature 2804 supplying theintestines 2802 is complex and highly ramified. It may necessary todetermine which blood vessels supply the tumor 2806 and to identifyblood vessels supplying blood to healthy intestinal tissue. The wideview image 2800 permits a surgeon to determine which blood vessel maysupply the tumor 2806. The surgeon may then test a blood vessel using aclamping device 2812 to determine if the blood vessel supplies the tumor2806 or not.

FIG. 178B depicts a secondary surgical display that may only display anarrow magnified view image 2810 of one portion of the surgical field2809. The narrow magnified view image 2810 may present a close-up viewof the vascular tree 2814 so that the surgeon can focus on dissectingonly the blood vessel of interest 2815. For resecting the blood vesselof interest 2815, a surgeon may use a smart RF cautery device 2816. Itmay be understood that any image obtained by the visualization systemmay include not only images of the tissue in the surgical site but alsoimages of the surgical instruments inserted therein. In some aspects,such a surgical display (either the primary display in FIG. 178A or thesecondary display in FIG. 178B) may also include indicia 2817 related tofunctions or settings of any surgical device used during the surgicalprocedure. For example, the indicia 2817 may include a power setting ofthe smart RF cautery device 2816. In some aspects, such smart medicaldevices may transmit data related to their operating parameters to thevisualization system to incorporate in display data to be transmitted toone or more display devices.

FIGS. 179A-C illustrate examples of a sequence of surgical steps for theremoval of an intestinal/colon tumor and which may benefit from the useof multi-image analysis at the surgical site. FIG. 179A depicts aportion of the surgical site, including the intestines 2932 and theramified vasculature 2934 supplying blood and nutrients to theintestines 2932. The intestines 2932 may have a tumor 2936 surrounded bya tumor margin 2937. A first light sensor module of a visualizationsystem may have a wide field of view 2930, and it may provide imagingdata of the wide field of view 2930 to a display system. A second lightsensor module of the visualization system may have a narrow or standardfield of view 2940, and it may provide imaging data of the narrow fieldof view 2940 to the display system. In some aspects, the wide fieldimage and the narrow field image may be displayed by the same displaydevice. In another aspect, the wide field image and the narrow fieldimage may be displayed by separate display devices.

During the surgical procedure, it my be important to remove not just thetumor 2936 but the margin 2937 surrounding it to assure complete removalof the tumor. A wide angle field of view 2930 may be used to image boththe vasculature 2934 as well as the section of the intestines 2932surrounding the tumor 2936 and the margin 2637. As noted above, thevasculature feeding the tumor 2936 and the margin 2637 should beremoved, but the vasculature feeding the surrounding intestinal tissuemust be preserved to provide oxygen and nutrients to the surroundingtissue. Transection of the vasculature feeding the surrounding colontissue will remove oxygen and nutrients from the tissue, leading tonecrosis. In some examples, laser Doppler imaging of the tissuevisualized in the wide angle field 2630 may be analyzed to provide aspeckle contrast analysis 2933, indicating the blood flow within theintestinal tissue.

FIG. 179B illustrates a step during the surgical procedure. The surgeonmay be uncertain which part of the vascular tree supplies blood to thetumor 2936. The surgeon may test a blood vessel 2944 to determine if itfeeds the tumor 2936 or the healthy tissue. The surgeon may clamp ablood vessel 2944 with a clamping device 2812 and determine the sectionof the intestinal tissue 2943 that is no longer perfused by means of thespeckle contrast analysis. The narrow field of view 2940 displayed on animaging device may assist the surgeon in the close-up and detailed workrequired to visualize the single blood vessel 2944 to be tested. Whenthe suspected blood vessel 2944 is clamped, a portion of the intestinaltissue 2943 is determined to lack perfusion based on the Doppler imagingspeckle contras analysis. As depicted in FIG. 159B, the suspected bloodvessel 2944 does not supply blood to the tumor 2935 or the tumor margin2937, and therefore is recognized as a blood vessel to be spared duringthe surgical procedure.

FIG. 179C depicts a following stage of the surgical procedure. In stage,a supply blood vessel 2984 has been identified to supply blood to themargin 2937 of the tumor. When this supply blood vessel 2984 has beensevered, blood is no longer supplied to a section of the intestine 2987that may include at least a portion of the margin 2937 of the tumor2936. In some aspects, the lack of perfusion to the section 2987 of theintestines may be determined by means of a speckle contrast analysisbased on a Doppler analysis of blood flow into the intestines. Thenon-perfused section 2987 of the intestines may then be isolated by aseal 2985 applied to the intestine. In this manner, only those bloodvessels perfusing the tissue indicated for surgical removal may beidentified and sealed, thereby sparing healthy tissue from unintendedsurgical consequences.

In some additional aspects, a surgical visualization system may permitimaging analysis of the surgical site.

In some aspects, the surgical site may be inspected for theeffectiveness of surgical manipulation of a tissue. Non-limitingexamples of such inspection may include the inspection of surgicalstaples or welds used to seal tissue at a surgical site. Cone beamcoherent tomography using one or more illumination sources may be usedfor such methods.

In some additional aspects, an image of a surgical site may havelandmarks denoted in the image. In some examples, the landmarks may bedetermined through image analysis techniques. In some alternativeexamples, the landmarks may be denoted through a manual intervention ofthe image by the surgeon.

In some additional aspects, non-smart ready visualizations methods maybe imported for used in Hub image fusion techniques.

In additional aspects, instruments that are not integrated in the Hubsystem may be identified and tracked during their use within thesurgical site. In this aspect, computational and/or storage componentsof the Hub or in any of its components (including, for example, in thecloud system) may include a database of images related to EES andcompetitive surgical instruments that are identifiable from one or moreimages acquired through any image acquisition system or through visualanalytics of such alternative instruments. The imaging analysis of suchdevices may further permit identification of when an instrument isreplaced with a different instrument to do the same or a similar job.The identification of the replacement of an instrument during a surgicalprocedure may provide information related to when an instrument is notdoing the job or a failure of the device.

Cloud System Hardware and Functional Modules

Aspects of the present disclosure include a cloud-based medicalanalytics system that communicatively couples to multiple Hub systems,as described above, and multiple robotic surgical devices, describedmore below. The cloud-based medical analytics system is configured toreceive data pertaining to a patient and/or medical procedure andprovide various integrated processes that span multiple Hub systems andmultiple robotic surgical devices. The cloud-based medical analyticssystem generally aggregates data and forms insights based on theaggregated data that may not otherwise be concluded without gatheringthe various disparate data sources that span the multiple Hub systemsand robotic devices. Described below are various examples of differenttypes of functions and structures present in the cloud-based medicalanalytics system that provide more detail toward these ends.

FIG. 180 is a block diagram of the computer-implemented interactivesurgical system, in accordance with at least one aspect of the presentdisclosure. In one aspect, the computer-implemented interactive surgicalsystem is configured to monitor and analyze data related to theoperation of various surgical systems that include surgical hubs,surgical instruments, robotic devices and operating theaters orhealthcare facilities. The computer-implemented interactive surgicalsystem comprises a cloud-based analytics system. Although thecloud-based analytics system is described as a surgical system, it isnot necessarily limited as such and could be a cloud-based medicalsystem generally. As illustrated in FIG. 180 , the cloud-based analyticssystem comprises a plurality of surgical instruments 7012 (may be thesame or similar to instruments 112), a plurality of surgical hubs 7006(may be the same or similar to hubs 106), and a surgical data network7001 (may be the same or similar to network 201) to couple the surgicalhubs 7006 to the cloud 7004 (may be the same or similar to cloud 204).Each of the plurality of surgical hubs 7006 is communicatively coupledto one or more surgical instruments 7012. The hubs 7006 are alsocommunicatively coupled to the cloud 7004 of the computer-implementedinteractive surgical system via the network 7001. The cloud 7004 is aremote centralized source of hardware and software for storing,manipulating, and communicating data generated based on the operation ofvarious surgical systems. As shown in FIG. 180 , access to the cloud7004 is achieved via the network 7001, which may be the Internet or someother suitable computer network. Surgical hubs 7006 that are coupled tothe cloud 7004 can be considered the client side of the cloud computingsystem (i.e., cloud-based analytics system). Surgical instruments 7012are paired with the surgical hubs 7006 for control and implementation ofvarious surgical procedures or operations as described herein.

In addition, surgical instruments 7012 may comprise transceivers fordata transmission to and from their corresponding surgical hubs 7006(which may also comprise transceivers). Combinations of surgicalinstruments 7012 and corresponding hubs 7006 may indicate particularlocations, such as operating theaters in healthcare facilities (e.g.,hospitals), for providing medical operations. For example, the memory ofa surgical hub 7006 may store location data. As shown in FIG. 180 , thecloud 7004 comprises central servers 7013 (may be same or similar toremote server 7013), hub application servers 7002, data analyticsmodules 7034, and an input/output (“I/O”) interface 7006. The centralservers 7013 of the cloud 7004 collectively administer the cloudcomputing system, which includes monitoring requests by client surgicalhubs 7006 and managing the processing capacity of the cloud 7004 forexecuting the requests. Each of the central servers 7013 comprises oneor more processors 7008 coupled to suitable memory devices 7010 whichcan include volatile memory such as random-access memory (RAM) andnon-volatile memory such as magnetic storage devices. The memory devices7010 may comprise machine executable instructions that when executedcause the processors 7008 to execute the data analytics modules 7034 forthe cloud-based data analysis, operations, recommendations and otheroperations described below. Moreover, the processors 7008 can executethe data analytics modules 7034 independently or in conjunction with hubapplications independently executed by the hubs 7006. The centralservers 7013 also comprise aggregated medical data databases 2212, whichcan reside in the memory 2210.

Based on connections to various surgical hubs 7006 via the network 7001,the cloud 7004 can aggregate data from specific data generated byvarious surgical instruments 7012 and their corresponding hubs 7006.Such aggregated data may be stored within the aggregated medicaldatabases 7012 of the cloud 7004. In particular, the cloud 7004 mayadvantageously perform data analysis and operations on the aggregateddata to yield insights and/or perform functions that individual hubs7006 could not achieve on their own. To this end, as shown in FIG. 180 ,the cloud 7004 and the surgical hubs 7006 are communicatively coupled totransmit and receive information. The I/O interface 7006 is connected tothe plurality of surgical hubs 7006 via the network 7001. In this way,the I/O interface 7006 can be configured to transfer information betweenthe surgical hubs 7006 and the aggregated medical data databases 7011.Accordingly, the I/O interface 7006 may facilitate read/write operationsof the cloud-based analytics system. Such read/write operations may beexecuted in response to requests from hubs 7006. These requests could betransmitted to the hubs 7006 through the hub applications. The I/Ointerface 7006 may include one or more high speed data ports, which mayinclude universal serial bus (USB) ports, IEEE 1394 ports, as well asWi-Fi and Bluetooth I/O interfaces for connecting the cloud 7004 to hubs7006. The hub application servers 7002 of the cloud 7004 are configuredto host and supply shared capabilities to software applications (e.g.,hub applications) executed by surgical hubs 7006. For example, the hubapplication servers 7002 may manage requests made by the hubapplications through the hubs 7006, control access to the aggregatedmedical data databases 7011, and perform load balancing. The dataanalytics modules 7034 are described in further detail with reference toFIG. 181 .

The particular cloud computing system configuration described in thepresent disclosure is specifically designed to address various issuesarising in the context of medical operations and procedures performedusing medical devices, such as the surgical instruments 7012, 112. Inparticular, the surgical instruments 7012 may be digital surgicaldevices configured to interact with the cloud 7004 for implementingtechniques to improve the performance of surgical operations. Varioussurgical instruments 7012 and/or surgical hubs 7006 may comprise touchcontrolled user interfaces such that clinicians may control aspects ofinteraction between the surgical instruments 7012 and the cloud 7004.Other suitable user interfaces for control such as auditory controlleduser interfaces can also be used.

FIG. 181 is a block diagram which illustrates the functionalarchitecture of the computer-implemented interactive surgical system, inaccordance with at least one aspect of the present disclosure. Thecloud-based analytics system includes a plurality of data analyticsmodules 7034 that may be executed by the processors 7008 of the cloud7004 for providing data analytic solutions to problems specificallyarising in the medical field. As shown in FIG. 181 , the functions ofthe cloud-based data analytics modules 7034 may be assisted via hubapplications 7014 hosted by the hub application servers 7002 that may beaccessed on surgical hubs 7006. The cloud processors 7008 and hubapplications 7014 may operate in conjunction to execute the dataanalytics modules 7034. Application program interfaces (APIs) 7016define the set of protocols and routines corresponding to the hubapplications 7014. Additionally, the APIs 7016 manage the storing andretrieval of data into and from the aggregated medical databases 7012for the operations of the applications 7014. The caches 7018 also storedata (e.g., temporarily) and are coupled to the APIs 7016 for moreefficient retrieval of data used by the applications 7014. The dataanalytics modules 7034 in FIG. 181 include modules for resourceoptimization 7020, data collection and aggregation 7022, authorizationand security 7024, control program updating 7026, patient outcomeanalysis 7028, recommendations 7030, and data sorting and prioritization7032. Other suitable data analytics modules could also be implemented bythe cloud 7004, according to some aspects. In one aspect, the dataanalytics modules are used for specific recommendations based onanalyzing trends, outcomes, and other data.

For example, the data collection and aggregation module 7022 could beused to generate self-describing data (e.g., metadata) includingidentification of notable features or configuration (e.g., trends),management of redundant data sets, and storage of the data in paireddata sets which can be grouped by surgery but not necessarily keyed toactual surgical dates and surgeons. In particular, pair data setsgenerated from operations of surgical instruments 7012 can compriseapplying a binary classification, e.g., a bleeding or a non-bleedingevent. More generally, the binary classification may be characterized aseither a desirable event (e.g., a successful surgical procedure) or anundesirable event (e.g., a misfired or misused surgical instrument7012). The aggregated self-describing data may correspond to individualdata received from various groups or subgroups of surgical hubs 7006.Accordingly, the data collection and aggregation module 7022 cangenerate aggregated metadata or other organized data based on raw datareceived from the surgical hubs 7006. To this end, the processors 7008can be operationally coupled to the hub applications 7014 and aggregatedmedical data databases 7011 for executing the data analytics modules7034. The data collection and aggregation module 7022 may store theaggregated organized data into the aggregated medical data databases2212.

The resource optimization module 7020 can be configured to analyze thisaggregated data to determine an optimal usage of resources for aparticular or group of healthcare facilities. For example, the resourceoptimization module 7020 may determine an optimal order point ofsurgical stapling instruments 7012 for a group of healthcare facilitiesbased on corresponding predicted demand of such instruments 7012. Theresource optimization module 7020 might also assess the resource usageor other operational configurations of various healthcare facilities todetermine whether resource usage could be improved. Similarly, therecommendations module 7030 can be configured to analyze aggregatedorganized data from the data collection and aggregation module 7022 toprovide recommendations. For example, the recommendations module 7030could recommend to healthcare facilities (e.g., medical serviceproviders such as hospitals) that a particular surgical instrument 7012should be upgraded to an improved version based on a higher thanexpected error rate, for example. Additionally, the recommendationsmodule 7030 and/or resource optimization module 7020 could recommendbetter supply chain parameters such as product reorder points andprovide suggestions of different surgical instrument 7012, uses thereof,or procedure steps to improve surgical outcomes. The healthcarefacilities can receive such recommendations via corresponding surgicalhubs 7006. More specific recommendations regarding parameters orconfigurations of various surgical instruments 7012 can also beprovided. Hubs 7006 and/or surgical instruments 7012 each could alsohave display screens that display data or recommendations provided bythe cloud 7004.

The patient outcome analysis module 7028 can analyze surgical outcomesassociated with currently used operational parameters of surgicalinstruments 7012. The patient outcome analysis module 7028 may alsoanalyze and assess other potential operational parameters. In thisconnection, the recommendations module 7030 could recommend using theseother potential operational parameters based on yielding better surgicaloutcomes, such as better sealing or less bleeding. For example, therecommendations module 7030 could transmit recommendations to a surgical7006 regarding when to use a particular cartridge for a correspondingstapling surgical instrument 7012. Thus, the cloud-based analyticssystem, while controlling for common variables, may be configured toanalyze the large collection of raw data and to provide centralizedrecommendations over multiple healthcare facilities (advantageouslydetermined based on aggregated data). For example, the cloud-basedanalytics system could analyze, evaluate, and/or aggregate data based ontype of medical practice, type of patient, number of patients,geographic similarity between medical providers, which medicalproviders/facilities use similar types of instruments, etc., in a waythat no single healthcare facility alone would be able to analyzeindependently. The control program updating module 7026 could beconfigured to implement various surgical instrument 7012 recommendationswhen corresponding control programs are updated. For example, thepatient outcome analysis module 7028 could identify correlations linkingspecific control parameters with successful (or unsuccessful) results.Such correlations may be addressed when updated control programs aretransmitted to surgical instruments 7012 via the control programupdating module 7026. Updates to instruments 7012 that are transmittedvia a corresponding hub 7006 may incorporate aggregated performance datathat was gathered and analyzed by the data collection and aggregationmodule 7022 of the cloud 7004. Additionally, the patient outcomeanalysis module 7028 and recommendations module 7030 could identifyimproved methods of using instruments 7012 based on aggregatedperformance data.

The cloud-based analytics system may include security featuresimplemented by the cloud 7004. These security features may be managed bythe authorization and security module 7024. Each surgical hub 7006 canhave associated unique credentials such as username, password, and othersuitable security credentials. These credentials could be stored in thememory 7010 and be associated with a permitted cloud access level. Forexample, based on providing accurate credentials, a surgical hub 7006may be granted access to communicate with the cloud to a predeterminedextent (e.g., may only engage in transmitting or receiving certaindefined types of information). To this end, the aggregated medical datadatabases 7011 of the cloud 7004 may comprise a database of authorizedcredentials for verifying the accuracy of provided credentials.Different credentials may be associated with varying levels ofpermission for interaction with the cloud 7004, such as a predeterminedaccess level for receiving the data analytics generated by the cloud7004. Furthermore, for security purposes, the cloud could maintain adatabase of hubs 7006, instruments 7012, and other devices that maycomprise a “black list” of prohibited devices. In particular, a surgicalhubs 7006 listed on the black list may not be permitted to interact withthe cloud, while surgical instruments 7012 listed on the black list maynot have functional access to a corresponding hub 7006 and/or may beprevented from fully functioning when paired to its corresponding hub7006. Additionally or alternatively, the cloud 7004 may flag instruments7012 based on incompatibility or other specified criteria. In thismanner, counterfeit medical devices and improper reuse of such devicesthroughout the cloud-based analytics system can be identified andaddressed.

The surgical instruments 7012 may use wireless transceivers to transmitwireless signals that may represent, for example, authorizationcredentials for access to corresponding hubs 7006 and the cloud 7004.Wired transceivers may also be used to transmit signals. Suchauthorization credentials can be stored in the respective memory devicesof the surgical instruments 7012. The authorization and security module7024 can determine whether the authorization credentials are accurate orcounterfeit. The authorization and security module 7024 may alsodynamically generate authorization credentials for enhanced security.The credentials could also be encrypted, such as by using hash basedencryption. Upon transmitting proper authorization, the surgicalinstruments 7012 may transmit a signal to the corresponding hubs 7006and ultimately the cloud 7004 to indicate that the instruments 7012 areready to obtain and transmit medical data. In response, the cloud 7004may transition into a state enabled for receiving medical data forstorage into the aggregated medical data databases 7011. This datatransmission readiness could be indicated by a light indicator on theinstruments 7012, for example. The cloud 7004 can also transmit signalsto surgical instruments 7012 for updating their associated controlprograms. The cloud 7004 can transmit signals that are directed to aparticular class of surgical instruments 7012 (e.g., electrosurgicalinstruments) so that software updates to control programs are onlytransmitted to the appropriate surgical instruments 7012. Moreover, thecloud 7004 could be used to implement system wide solutions to addresslocal or global problems based on selective data transmission andauthorization credentials. For example, if a group of surgicalinstruments 7012 are identified as having a common manufacturing defect,the cloud 7004 may change the authorization credentials corresponding tothis group to implement an operational lockout of the group.

The cloud-based analytics system may allow for monitoring multiplehealthcare facilities (e.g., medical facilities like hospitals) todetermine improved practices and recommend changes (via therecommendations module 2030, for example) accordingly. Thus, theprocessors 7008 of the cloud 7004 can analyze data associated with anindividual healthcare facility to identify the facility and aggregatethe data with other data associated with other healthcare facilities ina group. Groups could be defined based on similar operating practices orgeographical location, for example. In this way, the cloud 7004 mayprovide healthcare facility group wide analysis and recommendations. Thecloud-based analytics system could also be used for enhanced situationalawareness. For example, the processors 7008 may predictively model theeffects of recommendations on the cost and effectiveness for aparticular facility (relative to overall operations and/or variousmedical procedures). The cost and effectiveness associated with thatparticular facility can also be compared to a corresponding local regionof other facilities or any other comparable facilities.

The data sorting and prioritization module 7032 may prioritize and sortdata based on criticality (e.g., the severity of a medical eventassociated with the data, unexpectedness, suspiciousness). This sortingand prioritization may be used in conjunction with the functions of theother data analytics modules 7034 described above to improve thecloud-based analytics and operations described herein. For example, thedata sorting and prioritization module 7032 can assign a priority to thedata analysis performed by the data collection and aggregation module7022 and patient outcome analysis modules 7028. Different prioritizationlevels can result in particular responses from the cloud 7004(corresponding to a level of urgency) such as escalation for anexpedited response, special processing, exclusion from the aggregatedmedical data databases 7011, or other suitable responses. Moreover, ifnecessary, the cloud 7004 can transmit a request (e.g., a push message)through the hub application servers for additional data fromcorresponding surgical instruments 7012. The push message can result ina notification displayed on the corresponding hubs 7006 for requestingsupporting or additional data. This push message may be required insituations in which the cloud detects a significant irregularity oroutlier and the cloud cannot determine the cause of the irregularity.The central servers 7013 may be programmed to trigger this push messagein certain significant circumstances, such as when data is determined tobe different from an expected value beyond a predetermined threshold orwhen it appears security has been comprised, for example.

Additional example details for the various functions described areprovided in the ensuing descriptions below. Each of the variousdescriptions may utilize the cloud architecture as described in FIGS.180 and 181 as one example of hardware and software implementation.

Usage, Resource, and Efficiency Modeling for Medical Facility

Aspects of the present disclosure are presented for a cloud-basedanalytics system, communicatively coupled to a plurality of hubs andsmart medical instruments, and configured to provide customizedrecommendations to localized medical care facilities regarding usage ofmedical supplies and other resources to improve efficiency and optimizeresource allocation. A medical care facility, such as a hospital ormedical clinic, may develop a set of practices for procuring, using, anddisposing of various medical supplies that are often derived fromroutines and traditions maintained over time. The behaviors of a medicalfacility typically are risk-averse, and generally would be hesitant toadopt new and better practices unless and until convincingly shown of abetter practice. Similarly, even if a better usage or efficiency modelhas been developed in a nearby facility, it is difficult for a localfacility to adopt the improved practice because 1) each facility may bemore natively resistant to change from the outside and 2) there are manyunknowns for how or why the improved practice works in the nearbyfacility in relation to what the local facility does instead.Furthermore, even if a medical facility desired to improve itspractices, it may be unable to do so optimally because it lacks enoughknowledge from other similarly situated facilities, either in itsregion, according to a similar size, and/or according to similarpractices or patients, and the like.

To help facilitate the dissemination of improved practices acrossmultiple medical facilities, it would be desirable if a common sourcecould have knowledge of the contexts from multiple medical facilitiesand be able to determine what changes should be made for any particularmedical facility, based on the knowledge of the practices of any or allof the multiple facilities.

In some aspects, a cloud-based system communicatively coupled toknowledge centers in a medical facility, such as one or more medicalhubs, may be configured to aggregate medical resource usage data frommultiple medical facilities. The cloud-based system may then correlatethe medical resource usage data with outcomes from those facilities, andmay be able to derive various patterns within the data. For example, insome aspects, the cloud-based system may find which hospitals generatethe least amount of waste per unit cost, based on an aggregation of allwaste and procurement data obtained from medical facilities in a widegeographic region (e.g., all surgery centers in Japan). The cloud-basedsystem may be configured to identify which medical facility produced theleast amount of waste per unit cost, and then may analyze what practicesdifferentiate that medical facility. If a trend is found, thecloud-based system may disseminate this information to all of thesimilarly situated medical facilities to improve their practices. Thisanalysis may help improve inventory management, throughput efficiency,or overall efficiency of a medical facility. The improved inventorymanagement may help surgical devices and other medical resources beutilized at their peak performance levels for longer periods of time,compared to if resources were badly managed, and therefore medicaldevices may be continuously used while they are older and more worndown.

In general, the cloud-based system may be configured to aggregate datafrom multiple medical facilities, something that no single facilityalone would be able to accomplish on its own. Furthermore, thecloud-based system may be configured to analyze the large collection ofdata, controlling for common variables, such as type of practice, typeof patient, number of patients, geographic similarity, which facilitiesuse similar types of instruments, etc., that no single facility alonewould be able to analyze on its own.

In this way, the cloud-based system of the present disclosure may beable to find more accurate causalities that lead to best practices at aparticular facility, which can then be disseminated to all of the otherfacilities. Furthermore, the cloud-based system may be able to providethe data from all of the disparate sources that no single facility maybe able to do on its own.

Referring to FIG. 182 , shown is an example illustration of a tabulationof various resources correlated to particular types of surgicalcategories. There are two bars for each category, with the dashed linebars 7102, 7106, and 7110 representing unused and/or scrap resources,and the solid line bars 7104, 7108, and 7112 showing a totality ofresourced in use for that category. In this example, bars 7104, 7108,and 7112 show a total amount of endocutter cartridges, sponges, saline,fibrin sealants, sutures, and stapler buttresses, for thoracic,colorectal, and bariatric procedures, respectively, compared to thelower amounts 7102, 7106, and 7110 representing an amount of unusedresources for the thoracic, colorectal, and bariatric procedures,respectively.

The cloud system may be configured to identify wasted product that wasgathered and not used or gathered and used in a manner that was notbeneficial to the patient or the surgery. To do this, the cloud systemmay record in memory all records of inventory intake and disposal.During each intake, the inventory may be scanned and entered, and thebar codes of each inventory item may identify what type of product itis, as an example. In some aspects, smart disposal bins may be utilizedto automatically tabulate when a product is being disposed of. These maybe connected to the cloud system ultimately, either through one or moresurgical hubs or through a separate inventory management systemthroughout the entire facility. Each facility may be tracked by itslocation, for example through a set GPS coordinate, inputted address orthe like. This data may be organized in memory using one or moredatabases with various meta data associated with it, such as date andtime of use, location of origin, type of procedure used for ifapplicable, cost per item, expiration date if applicable, and so on.

In addition, the cloud system may be configured to identify misfired ormisused product and tracking of where the product was used, and mayarchive these results. For example, each surgical instrumentcommunicatively coupled to a surgical hub may transmit a record of whenthe instrument was fired, such as to fire a staple or apply ultrasonicenergy. Each record may be transmitted through the instrument andrecorded at the cloud system ultimately. The action by the instrumentmay be tied with an outcome, either at that instant or with an overalloutcome stating whether the procedure was successful or not. The actionmay be associated with a precise timestamp that places the action at anexact point during a surgery, where all of the actions of the surgeryare also automatically recorded to the cloud, including start and endtimes of the surgery. This enables all of the human medical care workersto focus on their respective duties during surgery, rather than worryabout an exact instance an action of a medical instrument occurred. Therecordings of the medical instruments can be used to identify whatproducts may be wasted during surgery, and the cloud system may beconfigured to also identify usage trends in this way.

In some aspects, the cloud system may be configured to perform trendinganalysis of the product tied to the overall length or amount of theproduct to identify short fires, or discarded product. For example, thecloud system may place the use of a product within a known period ofwhen a surgical procedure is occurring, with a time stamp. The cloudsystem may then record an amount of resources utilized during thatprocedure, and may compare the materials used in that procedure withsimilarly situated procedures performed elsewhere. Out of this, severalconclusions may be reached by the cloud system. For example, the cloudsystem may provide recommendations of a mix that provides smallerportions or an alternative usage that results in less wasted product. Asanother example, the cloud system may provide a suggestion or specifiedprotocol change of specialized kits that would assemble the product in amanner more aligned to the detected institution usage. As yet anotherexample, the cloud system may provide a suggestion or a change inprotocol for alternative product mixes that would be more aligned to thedetected usage and therefore should result in less wasted product. Asyet another example, the cloud system may provide a recommendation onhow to adjust a medical procedure during surgery based on timings ofactions occurring before or after an event that typically results inwasteful resources, such as misfirings or multiple firings, based onidentifying a correlation or pattern that actions during surgeryoccurring within a certain time interval relative to a prior action tendto result in wasteful actions. These analyses may be derived in partusing algorithms that attempt to optimize the available resources withthe rates of their disposals, taking into account various factors suchas misfirings, native practices of the surgeons or the facility atlarge, and so forth.

Still referring to FIG. 182 , based on the tabulation of the used andunused product, the cloud system can also generate several otherconclusions. For example, the cloud system may be configured to generatea correlation of unused product to cost overhead. The cloud system mayalso generate a calculation of expired product and how that impactsrates of change with inventory. It may also generate an indication ofwhere in the supply chain the product is being unused and how it isbeing accounted for. It may also generate ways to reduce costs orinventory space by finding substitutes of some resources over others forthe same procedure. This may be based on comparing similar practices atdifferent medical facilities that use different resources to perform thesame procedures.

In some aspects, the cloud system may be configured to analyze theinventory usage of any and all medical products and conduct procurementmanagement for when to acquire new product. The cloud system mayoptimize the utilization of inventory space to determine how best toutilize what space is available, in light of rates of usage for certainproducts compared to others. It may often be the case that inventory isnot closely monitored in terms of how long a product remains in storage.If certain products are utilized at slower rates, but there is a largeamount of it, it may be determined that the storage space is allocatedpoorly. Therefore, the cloud system may better apportion the storagespace to reflect actual resource usage.

To improve in this area, in some aspects, the cloud system may forexample, identify missing or insufficient product within an operatingroom (OR) for a specified procedure. The cloud system may then providean alert or notification or transmit data to display that deficiency atthe surgical hub in the OR. As another example, when a product is usedin the OR, it may communicate its usage information to the cloud, suchas activate a sensor or activation identification. The product may beregistered with a scan or a power on switch. Analysis of thisinformation for a given hospital coupled with its ordering information,may eventually inform the supply status and can enable orderingrecommendations. This may occur automatically, once the cloud systemregisters that products are being used in the OR, or through othermeans.

In some aspects, device utilization within a procedure is monitored bythe cloud system and compared for a given segment (e.g., individualsurgeon, individual hospital, network of hospitals, region, etc.)against device utilization for similar procedures in other segments.Recommendations are presented to optimize utilization based on unitresource used or expenditure spent to supply such resource. In general,the cloud system may focus on a comparison of product utilizationbetween different institutions that it is connected with.

FIG. 183 provides an example illustration of how the data is analyzed bythe cloud system to provide a comparison between multiple facilities tocompare use of resources. In general, the cloud system 7200 may obtainusage data from all facilities, such as any of the types of datadescribed with respect to FIG. 182 , and may associate each datum withvarious other meta data, such as time, procedure, outcome of theprocedure, cost, date of acquisition, and so forth. FIG. 183 shows anexample set of data 7202 being uploaded to the cloud 7200, each circlein the set 7202 representing an outcome and one or more resources andcontextual metadata that may be relevant to leading to the outcome. Inaddition, high performing outcomes 7204 and their associated resourcesand contextual metadata are also uploaded to the cloud 7200, though atthe time of upload, it may not be known which data has very goodoutcomes or simply average (or below average) outcomes. The cloud systemmay identify which use of resources is associated with better resultscompared to an average or expected outcome. This may be based ondetermining which resources last longer, are not wasted as often,ultimately cost less per unit time or unit resource, as some examples.The cloud system may analyze the data to determine best outcomes basedon any and all of these variables, or even one or more combinations ofthem. The trends identified may then be used to find a correlation ormay prompt request of additional data associated with these data points.If a pattern is found, these recommendations may be alerted to a user toexamine as possible ways to improve resource usage and efficiency.

The example graph 7206 provides a visual depiction of an example trendor pattern that the cloud may derive from examining the resource andoutcome data, according to some aspects. In this example, the cloudsystem may have analyzed resource and outcome data of number of staplerfirings and their relation to performance in surgery. The cloud systemmay have gathered the data from multiple medical facilities, andmultiple surgeons within each facility, based on automatically recordedfiring data during each surgery that is generated directly from theoperation of the surgical staplers themselves. The performance outcomesmay be based on post-op examinations and evaluations, and/or immediateoutcomes during surgery, such as whether there is a bleeding event or asuccessful wound closure. Based on all of the data, trends may bedetermined, and here, it may be discovered that there is a small windowof the number of firings that results in the best performance outcomes,at interval “a” as shown. The magnitude of this performance compared tothe most common number of firings is shown as interval “b.” Because thenumber of firings that results in the best outcomes may not be what iscommonly practiced, it may not be readily easily to have discoveredthese outcomes without the aggregation and analytical abilities of thecloud system.

As another example: cartridge type, color, and adjunct usage that aremonitored for sleeve gastrectomy procedures for individual surgeonswithin the same hospital may be obtained. The data may reveal an averageprocedure cost for one surgeon is higher for this surgeon when comparedto others within the same hospital, yet short term patient outcomesremain the same. The hospital is then informed and is encouraged to lookinto differences in device utilization, techniques, etc. in search ofoptimizing costs potentially through the elimination of adjuncts.

In some aspects, the cloud system may also identify specialty cases. Forexample, specific cost information provided within the hospital,including OR time, device utilization, and staff, may be identified.These aspects may be unique to a particular OR, or facility. The cloudsystem may be configured to suggest efficiencies in OR time usage(scheduling), device inventory, etc. across specialties (orthopedics,thoracic, colorectal, bariatric, etc.) for these specialty cases.

In some aspects, the cloud system may also be configured to comparecost-benefit of robotic surgery vs traditional methods, such aslaparoscopic procedures for given procedure type. The cloud system maycompare device costs, OR time, patient discharge times, efficacy of theprocedure done by the robot vs performed by surgeons exclusively, andthe like.

Linking of Local Usage Trends with the Resource Acquisition Behaviors ofthe Larger Data Set (Individualized Change)

According to some aspects of the cloud system, whereas the abovedisclosure focuses on a determination of efficiency (i.e., value) andoptimizing based on that, here, this section centers around onidentifying which local practices may be best disseminated to othersimilarly situated medical facilities.

A medical care facility, such as a hospital or medical clinic, maydevelop a set of practices for how to utilize medical devices for aidingmedical procedures that are often derived from routines and traditionsmaintained over time. The behaviors of a medical facility typically arerisk-averse, and generally would be hesitant to adopt new and betterpractices unless and until convincingly shown of a better practice.Similarly, even if a better practice for utilizing a device or foradjusting a procedure has been developed in a nearby facility, it isdifficult for a local facility to adopt the improved practice because 1)each facility may be more natively resistant to change from the outsideand 2) there are many unknowns for how or why the improved practiceworks in the nearby facility in relation to what the local facility doesinstead. Furthermore, even if a medical facility desired to improve itspractices, it may be unable to do so optimally because it lacks enoughknowledge from other similarly situated facilities, either in itsregion, according to a similar size, and/or according to similarpractices or patients, and the like.

To help facilitate the dissemination of improved practices acrossmultiple medical facilities, it would be desirable if a common sourcecould have knowledge of the contexts from multiple medical facilitiesand be able to determine what changes should be made for any particularmedical facility, based on the knowledge of the practices of any or allof the multiple facilities.

In some aspects, a cloud-based system communicatively coupled toknowledge centers in a medical facility, such as one or more medicalhubs, may be configured to aggregate resource utilization data andpatient outcomes from multiple medical facilities. The cloud-basedsystem may then correlate the resource utilization data with theoutcomes from those facilities, and may be able to derive variouspatterns within the data. For example, in some aspects, the cloud-basedsystem may find which hospitals produce better outcomes for a particulartype of procedure, based on an aggregation of all the patient outcomedata for that particular procedure collected in a wide geographic region(e.g., all surgery centers in Germany). The cloud-based system may beconfigured to identify which medical facility produced a betterprocedural outcome compared to the average across the geographic region,and then may analyze what differences in that procedure occur in thatmedical facility. If a trend is found and one or more differences areidentified, the cloud-based system may disseminate this information toall of the similarly situated medical facilities to improve theirpractices.

In general, the cloud-based system may be configured to aggregate datafrom multiple medical facilities, something that no single facilityalone would be able to accomplish on its own. Furthermore, thecloud-based system may be configured to analyze the large collection ofdata, controlling for common variables, such as type of practice, typeof patient, number of patients, geographic similarity, which facilitiesuse similar types of instruments, etc., that no single facility alonewould be able to analyze on its own.

In this way, the cloud-based system of the present disclosure may beable to find more accurate causalities that give rise to best practicesat a particular facility, which can then be disseminated to all of theother facilities. Furthermore, the cloud-based system may be able toprovide the data from all of the disparate sources that no singlefacility may be able to do on its own.

The cloud system may be configured to generate conclusions about theefficacy of any local facility in a number of ways. For example, thecloud system may determine if a local treatment facility is using aproduct mixture or usage that differs from the larger community andtheir outcomes are superior. The cloud system may then correlate thedifferences and highlight them for use in other facilities, othersurgical hub, or in clinical sales as some examples. In general, thisinformation may be disseminated widely in a way that no single facilitymay have had access or knowledge of, including the facility thatpracticed this improve procedure.

As another example, the cloud system may determine if the local facilityhas equal to or inferior outcomes to the larger community. The cloudsystem may then correlate suggestions and provide that information backto the local facility as recommendations. The system may display datashowing their performance in relation to others, and may also displaysuggestions on what that facility is doing compared to what everybodyelse is doing. Again, the local facility may not even know they have aninefficiency in that respect, nor may everybody else realize they areutilizing their resources more efficiently, and thus nobody would everknow to examine these issues without the cloud system having a biggerpicture of all of the data.

These suggestions can come in various forms. For example, the cloudsystem may provide recommendations at the purchasing level that suggestimprovements in cost for similar outcomes. As another example, the cloudsystem may provide recommendations at the OR level when the procedure isbeing planned and outfitted as the less desirable products are beingpulled suggest other techniques and product mixes that would be in linewith the broader community which is achieving higher outcomes. As yetanother example, the cloud system may display outcomes comparison needsto account for surgeon experience, possibly through a count of similarcases performed by that surgeon from cloud data. In some aspects, thelearning curve of an individual may be reported against an aggregatedlarger dataset, as expectation of improved outcomes, or of surgeonperformance relative to peers in obtaining a steady state outcome level.

FIG. 184 illustrates one example of how the cloud system 7300 maydetermine efficacy trends from an aggregated set of data 7302 acrosswhole regions, according to some aspects. Here, for each circle of theset of data 7302, device utilization, cost, and procedure outcomes for aprocedure is monitored and compared for a given segment (e.g.,individual surgeon, individual hospital, network of hospitals, region,etc.) against device utilization, cost, and procedure outcomes forsimilar procedures in other segments. These data may possess metadatathat associates it to a particular facility. In general, an outcome of aprocedure may be linked to multiple types of data associated with it,such as what resources were used, what procedure was performed, whoperformed the procedure, where the procedure was performed, and so on.The data linked to the outcome may then be presented as a data pair. Thedata may be subdivided in various ways, such as between good andinferior outcomes, filtered by particular facilities, particulardemographics, and so forth. A regional filter 7304 is visually depictedas an example. The data set 7302 contains both good outcomes andinferior outcomes, with the inferior outcomes being darkened forcontrast.

FIG. 184 also shows examples of charts that have these distinctions madeand may be derived from the aggregated data set 7302, using one or moredata pairs. Chart 7306 shows a global analysis in one example, while aregionally segmented analysis is provided in the other chart 7308.Statistical analysis may be performed to determine whether the outcomesare statistically significant. In chart 7306, the cloud system maydetermine that no statistical difference was found between good outcomesand inferior outcomes based on rates of occurrence. In contrast, inchart 7308, the cloud system may determine that there is a statisticallyhigher occurrence of inferior outcomes for a given region, whenfiltering for a particular region. Recommendations are presented toshare outcomes vs. cost vs. device utilization and all combinationstherein to help inform optimization of outcomes against procedure costswith device utilization potentially being a key contributor ofdifferences, according to some aspects.

As another example, a cartridge type and color are monitored forlobectomy procedures for individual surgeons within the same hospital.The data reveals average cost for one surgeon is higher on average forthis surgeon, yet average length of stay is less. The hospital isinformed by the cloud system and is encouraged to look into differencesin device utilization, techniques, etc. in search of improving patientoutcomes.

In some aspects, the cloud system may also be configured to providepredictive modeling of changes to procedures, product mixes, and timingfor a given localized population or for the general population as awhole. The predictive modeling may be used to assess impact on resourceutilization, resource efficiency, and resource performance, as someexamples.

FIG. 185 provides an example illustration of some types of analysis thecloud system may be configured to perform to provide the predictingmodeling, according to some aspects. The cloud system may combine itsknowledge of the required steps and instruments for performing aprocedure, and may compare the different avenues via various metrics,such as resources utilized, time, procedural cost, and the like. In thisexample of chart 7400, a thoracic lobectomy procedure is analyzed usingtwo different types of methods to perform the same procedure. Option Adescribes a disposable ultrasonic instrument as the method forperforming the procedure, while Option B shows a combination ofdifferent methods that in the aggregate perform the same procedure. Thegraphical illustration may help a surgeon or administrator see how theresources are utilized and their cost. Option B is broken down intomultiple sections, including sterilization cost, reusable dissectors andadditional time in the OR for performing the procedure. The cloud systemmay be configured to convert these somewhat abstract notions into aquantitative cost value based on combining its knowledge of time spentin the OR, staff salaries and resource costs per unit time in the OR,and resources utilized for sterilization and reusable dissectors andtheir associated costs. The cloud system may be configured to associatethe various amounts of resources and costs with its knowledge of therequired steps to perform the thoracic lobectomy procedure using theprescribed method in Option B.

As another example, chart 7404 in FIG. 185 shows a comparison betweenusing an ultrasonic long dissector and a monopolar reusable dissector toperform various portions of a procedure. Chart 7404 shows a comparisonin terms of time needed to perform each portion of the procedure foreach instrument. The surgeon may then be able to select which instrumentmay be desired for a particular procedure. The breakout times may beautomatically recorded empirically during live procedures, with thetimes for each portion of the overall procedure broken out due to thecloud system's knowledge of the expected sequence to perform theprocedure. Demarcations between each portion may be set by a surgeonproviding an input to manually denote when each change occurs. In othercases, the cloud system may utilize situational awareness to determinewhen a portion of the procedure has ended based on the way the devicesare used and not used. The cloud system may aggregate a number of theseprocedures, performed across multiple surgeons and multiple facilities,and then compute an average time for each section, as an example.

As another example, chart 7402 in FIG. 185 shows an example graphicalinterface for comparing relative cost when utilizing the ultrasonic longdissector or a monopolar reusable dissector, according to some aspect.The value of each instrument per unit time is displayed for a particularprocedure. The data used to generate these values may be similar tothose obtained for charts 7400 and 7404, as some examples. The graphicaldisplay may allow for a succinct description of the key points ofefficiency that would be most useful to make a determination. Thisanalysis may help a surgeon see how valuable each instrument is for agiven procedure.

In general, to perform the predictive modeling, the cloud system maycombine its knowledge of the exact steps to perform a procedure, whatinstruments may be used to perform each step, and its aggregated datafor how each instrument performs each particular step. A surgeon may nothave the combination of such knowledge in order to provide such anassessment alone. The predictive modeling therefore may be the result ofcontinued monitoring and acquisition of data across multiple facilities,the likes of which would not be possible without the cloud system.

In some aspects, the cloud system may also derive the distilledinformation from multiple sources (e.g., HUB data collection sources,literature, etc.) to identify the optimal procedure technique. Variousother examples for how predictive modeling may be utilized include:

-   (1) sigmoidectomy: multi-quadrant surgery; which is the best order    of operations, etc.;-   (2) RYGB: what is the ideal limb length, etc. based on the    circumstances for this patient;-   (3) Lobectomy: how many and which lymph nodes should be removed; and-   (4) VSG: Bougie size and distance from pylorus.

In some aspects, when a suggestion is made to a surgeon, the surgeon isgiven the option to decline future suggestions like this, or tocontinue. In addition, through interface with the hub, the surgeon mayinquire to the cloud system additional information to inform his or herdecision. For example, the surgeon may want to isolate the times to amore localized set of data, such as the particular facility or a certaindemographic that better caters to the patient undergoing the surgery.The data may change, for example, if the patient is a child or thepatient is a woman.

Device Setup Modifications Based on Surgeon, Regional, Hospital, orPatient Parameters (Preoperatively)

Similar to the above section, the cloud-based system may also beconfigured to monitor smart instrument configurations and, moregenerally, configurations that utilize multiple smart instruments, suchas an operating room preparing for surgery. For similar reasons asdescribed above, such as to improve medical efficacy and efficiency, itmay be useful to compare a procedural setup at any particular medicalfacility to aggregate data pertaining to the procedural setups atmultiple other medical facilities.

The cloud-based system of the present disclosure may be configured toaggregate data pertaining to smart medical instrument configurations andoperating room (OR) setups that utilize multiple smart medicalinstruments. The smart medical instruments may include: manual devicesthat are communicatively coupled to a medical data tower and areconfigured to generate sensor data; and robotic instruments that performprocedures in a more automated fashion. The cloud-based system may beconfigured to detect irregularities in an OR setup, either pertaining towhat devices are present in the room and/or what materials are used tocreate a product mix for a medical procedure. The irregularities may bebased on comparing the materials and equipment present in the OR withother setups from other medical facilities for a similar situation. Thecloud system may then generate a change in firmware, software, or othersettings and transmit those changes to the surgical devices like adevice update.

In this way, the cloud-based system of the present disclosure may beable to identify errors and find more accurate causalities that giverise to best practices at a particular facility, which can then bedisseminated to all of the other facilities. Furthermore, thecloud-based system may be able to provide the data from all of thedisparate sources that no single facility may be able to do on its own.This can lead to safe and more efficient operating room procedures andmedical practices in general.

In some aspects, the cloud system may be configured to providerecommendations of instrument configurations, and even generate theappropriate device settings changes, to customize performance to that ofa pre-specified user.

For example, the cloud system may focus on a surgical device user orsurgeon based on a comparison of current usage of a device with thehistoric trends of a larger data set. As some examples, the cloud systemmay provide recommendations of what type of cartridge to use based onwhat the user has previously used for the particular procedure or justwhat the particular surgeon desires in general. The cloud system mayaccess data based on the particular surgeon, the type of procedure, andthe type of instruments used in order to make this determination.

As another example, the cloud system may provide a recommendation basedon an identified anatomy indicated in a display of the cartridge. Asanother example, the cloud system may provide a recommendation byreferring to a baseline surgical device clamping and firing speed, basedon local previous usage data that it has stored in its memory.

As yet another example, the cloud system may conduct a comparison ofcurrent device tissue interaction against a historical average for thesame surgeon, or for the same step in the same procedure for a segmentof surgeons in the database. The cloud system again may have access toall steps used to perform a procedure, and may access a catalog of alldata when performing a particular step in a procedure across allsurgeons who have ever performed that procedure in its network. Therecommendation may also come from an analysis of how the currentsurgical device has been observed to interact with tissue historically.This type of analysis may be useful because it is often not the casethat large amounts of live patient data can be collected for how asurgical device interacts precisely with the tissue. Furthermore, asurgeon typically knows only his or her experience, and does not haveoutside knowledge of what other surgeons experience for the sameprocedure. The cloud, on the other hand, is capable of collecting all ofthis data and providing new insights that any individual surgeon wouldnot know alone.

As another example: In stapling, more than one of the following areknown: cartridge color, stapler type, procedure, procedure step, patientinformation, clamp force over time, prior firing information, endeffector deformations, etc. This information is compared against ahistorical average for a similar dataset. The current situation iscompared against this average, informing the user about the nature ofthe current firing.

FIG. 186 provides a graphical illustration of a type of example analysisthe cloud system may perform to provide these recommendations, accordingto some aspects. In this example, chart 7500 shows data for parenchymastaple firing analysis. In the bar graphs 7502 are various types ofstaples used, where each color of staple reflects a different amount offorce applied to the surgical site. The y axis (on the left) associatedwith the bar graphs 7502 reflects a percent level of usage of that typeof staple color, and each color shows bar graphs for three differentcategories: regional average usage (in Japan in this case), globalaverage usage with best outcomes, and the local facility average usage.Based on this data, the cloud system may be configured to develop arecommendation for what staples to change to for a given situation. Aseries of suggested actions is shown in chart 7506 as a result. Thechart 7500 also shows a set of line graphs 7504 that reflect apercentage of prolonged air leaks (the y axis on the right) for eachcolor used, and for each type of category (regional, global average,facility average). If staples are too thick and do not match the levelof tissue thickness, there could be holes in the staples that lead toundesirable air leaks. Here, the cloud system may provide arecommendation based on all of the data shown as well as data not shown,according to some aspects. The cloud system may simply provide arecommendation in the form of a letter as the label, and the surgeon mayverify whether the data supports such a finding and decide to accept thecloud system's recommendation.

As another example, the cloud system may be configured to provide arecommendation of ultrasonic blade lengths or capacities based on likelyto encounter vascular structures in a procedure. Similar to what isdescribed above in reference to FIG. 186 , the cloud system may collectthe relevant data for blade lengths, and their outcomes that have beenobtained from multiple surgical hubs, and illustrate the variousoutcomes for using different blade lengths on a particular procedure. Arecommendation may be provided in a graphical display where the surgeoncan verify the recommendation using the graphical presentation createdby the cloud system.

In some aspects, the cloud system is also configured to providerecommendations to the staff about which devices to pull for an upcomingprocedure. These recommendations may be based on a combination ofsurgeon preference (pick list) against historical device utilizationrates for the same procedures performed by some segment of the largerdatabase, as well as average recommendations or utilizations acrossdifferent facilities that produce the best results. The data may beobtained by pairing good outcomes with the metadata, such as whatdevices were used to achieve those good outcomes. Recommendations can beinfluenced by other factors, including patient information, demographicdata, etc.

Relatedly, in some aspects, the cloud system may also provideidentification of pulled instruments that might not be the preferreddevice for a given procedure. The blacklisting of sorts can more clearlyeliminate any obviously flaw uses of devices to help surgeons make thebest decisions. This data may be obtained from manufacturer input,analysis of poor outcomes, specific input provided to the cloud system,and so on.

In addition, based on interrogating tissue for properties (elasticity,impedance, perfusion rate), a specific device with a given parameter set(clamp preload) could be suggested to be used from current stock ininventory by the cloud system. Some of the metadata associated with theoutcomes of past procedures may include a description of the type oftissue being operated on, and an associated description of the physicalcharacteristics of that tissue. The cloud system may then draw trends orpatterns based on different types of procedures, but having in commonall procedures that deal with similar types of tissue. This kind ofanalysis may be used as a secondary recommendation, when a new orunknown procedure must take place and new suggestions are welcome. Ifthe recommendation is accepted, the cloud system may be configured togenerate the change in parameters and transmit them to theinterconnected medical device, through the surgical hub, to make themedical device readily available for use in the adjusted procedure.

In some aspects, the device setup recommendations can includesuggestions of adjuncts for devices based on the pre-surgery imaging orlocally collected data during the beginning of a procedure. That is,this suggestion of adjuncts may be for use on or with devices based onthe local correlation of use to efficacy of the device. As an example,based on a given procedure, surgeon, and patient information, bleedingin a case must be tightly controlled, and therefore the cloud system mayconclude that a buttress is recommended on all staple firings.

In some aspects, the cloud system may also be configured to provideawareness of any newly-launched products that are available and suitablefor operation as well as instructions for use (IFU). The data may begathered from one or more surgical hubs, or from direct factory inputfor the newly-launched products. The cloud system can download theinformation and make the information displayable to multiple medicalhubs across multiple facilities.

In some aspects, regarding any of the above examples for recommendationsbeing provided by the cloud system, the cloud system may also converselyprovide alerts or other signals when a device or suggested setup is notfollowed or is disregarded. The cloud system may be configured to accessprocedural data from a surgical hub during a surgical procedure, forexample. The surgical hub may collect data for what type of devices arein use during a procedure. The cloud system may monitor the progress ofthe procedure by verifying if an accepted method or device is used inthe correct or prescribed order for the procedure. If there is adeviation, in that a particular device is not expected or a step ismissed, the cloud system may send an alert to the surgical hub that aparticular device is not being used properly, as an example. This wouldoccur in real time, as the timing of the procedure is important for thepatient's safety.

Medical Facility Segmented Individualization of Instrument Function

In some aspects, the cloud-based system may also be configured toprovide recommendations or automatically adjust surgical instrumentsettings to account for specific differences at a medical facility.While there are a number of similarities that can be normalized acrossmultiple facilities, there may also be particular differences thatshould be accounted for. For example, patient demographic differences,patient physiological differences more native to a local population,procedural differences—for example preferences by each individualsurgeon—and region specific instrument availability or other differencesmay inspire certain adjustments to be made at any particular medicalfacility.

The cloud-based system of the present disclosure may be configured toaggregate not only data pertaining to smart medical instrumentconfigurations and operating room (OR) setups that utilize multiplesmart medical instruments, but also data that highlight specificdifferences that may be unique to that region or that particular medicalfacility. The cloud-based system may then factor in adjustments todevice settings or recommendations to changes in procedures based onthese differences. For example, the cloud-based system may first providea baseline recommendation for how a smart instrument should be used,based on best practices discovered in the aggregate data. Then, thecloud-based system may augment the recommendation to account for one ormore unique differences specific to a medical facility. Examples ofthese differences are described above. The cloud-based system may bemade aware of what demographics and patient data gave rise to theoptimal baseline procedure, and then compare the local facilitydemographics and patient data against that. The cloud-based system maydevelop or extrapolate a correlation from that baseline setting in orderto develop an adjustment or offset that accounts for the differences indemographics and patient data.

In this way, the cloud-based system of the present disclosure may beable to make optimal adjustments specific to each medical facility oreven specific to each operating room, or surgeon. The adjustments mayoffer improved performance that take into account the observed bestpractices as well as any unique differences.

In some aspects, the cloud system may be configured to provide changesto instrument variation of usage to improve outcomes. For example, thecloud system may determine a localized undesirable effect that is due toa specific manner of utilizing a surgical device. FIG. 187 provides anillustration of how the cloud system may conduct analysis to identify astatistical correlation to a local issue that is tied to how a device isused in the localized setting. The cloud 7600 may aggregate usage dataof all types of devices and record their outcomes. The data set may befiltered down to only those outcomes that utilized the particular devicein question. The cloud system may then perform statistical analysis todetermine if there is a trend in how the procedures are performed at aparticular facility when utilizing that device. A pattern may emergethat suggests there is a consistent flaw in how the device is used atthat facility, represented as the data points 7602 that demonstrate thestatistical correlation. Additional data may then be examined, to see ifa second pattern may arise in comparison to how others are using thedevice in the aggregate. A suggestion may be provided once a pattern isidentified and addressed to the local outlier 7604. In other cases, thecloud system may provide a facility-specific update to the device tooffset the local practice of how that device is used.

In some aspects, the cloud system may be configured to communicate thedeviation to the specific user and the recommendation of a differingtechnique or usage to improve outcomes from the specific device. Thecloud system may transmit the data for display at the surgical hub toillustrate what changes ought to be made.

As an example: A stapler configured with a means to sense the forcerequired to clamp the device transmits data indicating that the clampforce is still rapidly changing (viscoelastic creep) when the surgeoninitiates firing of the staple, and it is observed that the staple linebleeds more often than expected. The cloud system and/or device is ableto communicate a need to wait longer (e.g., 15 seconds) before firingthe device to improve outcomes. This may be based on performing thestatistical analysis described in FIG. 187 using data points fromsimilar procedures aggregated from multiple surgeons and multiplefacilities. In the moment of the surgery, it would be infeasible orimpractical for anybody on the surgery team to come to these conclusionswithout the help of the cloud system aggregating such knowledge andarriving at such conclusions.

In some aspects, the cloud system may also be configured for intentionaldeployment of control algorithms to devices with an in-use criteriameeting specific criteria. For regional differences, the cloud systemmay adjust the control algorithms of various surgical devices. Adifferent amount of force may be applied to a device for patients in adifferent demographic, for example. As another example, surgeons mayhave different uses for a type of surgical device, and controlalgorithms can be adjusted to account for this. The cloud system may beconfigured to send out a wide area update to a device, and may targetthe regional and specific instrument IDs which allow for targetedupdates to their control programs.

In some aspects, the cloud system may provide for coding of the serialnumbers of sales units and/or individual devices, which enables updatedcontrol programs to be pushed to a specific device or specific groups ofdevices based on meeting a specific criteria or threshold.

In addition, according to some aspects, the cloud system may beconfigured to perform analysis of peri-operative data against outcomesdata seeking correlations that identify exceptional results (positiveand negative). The analysis may be performed at multiple levels (e.g.,individual, hospital, and geographic (e.g., city, county, state,country, etc.) filters). Furthermore, regional corroboration of improvedoutcomes may be target for only a limited geographic area, as it isknown that the changes occur only within a limited area. The ability totune devices to regional preferences, techniques, and surgicalpreferences may allow for nuanced improvements for regionally specificareas.

In addition to directly changing instrument settings, the cloud systemmay also be configured to provide recommendations on differentinstruments or equivalent device suggestions due to regionalavailability. That is, an equivalent suggestion to a device to perform aparticular function may be recommended by the cloud system, in the eventa device is lacking and a particular region has an excess or generalavailability of the different device that may be used to serve anequivalent purpose.

For example, the cloud system may determine that PPH hemorrhoid staplingdevices or curved cutter 30 devices are only available in Italy due to aunique procedure configuration or teaching hospital procedure design. Asanother example, the cloud system may determine that there is anAsia-specific TX and open vascular stapler use due to cost sensitivity,lack of laparoscopic adoption, and teaching hospital preferredtechniques and patient thoracic cavity size. As another example, thecloud system may provide awareness messages to OR staff of sub-standardknock-off products available in a certain region. This data may bederived from an ingestion of information from multiple sources, such asinputs provided by experts and doctors, and employing machine learningand natural language processing to interpret trends and news related toa local area. FIG. 188 provides a graphical illustration of an exampleof how some devices may satisfy an equivalent use compared to anintended device. Here, a circular stapling device 7702 is compared to acompression ring 7704 for use in a PPH stapler 7700 for hemorrhoidopexyprocedures. The type of analysis performed to reach the recommendationsby the cloud system may be similar to those described in FIG. 187 . Thecloud system may provide a display of this suggestion, as well as ananalysis of its efficiency and resource utilization, in example display7706 that may be shown at a display in a surgical hub. In this case, theinstrument cost is compared, as well as time and efficacy for each typeof instrument. The cloud system may derive these recommendations byobtaining usage examples from different facilities, observing how otherfacilities and doctors treat the same procedure.

In some aspects, the cloud system may also be configured to provide asurgical hub decision tree and local suggestions of post-operative care,based on data processed during the procedure and Cloud Analyticstrending of results or performance of the devices aggregated from largerpopulation sets.

In some aspects, the cloud system may provide update-able decision treesfor post-operative care suggestions, based on device measuredsituational usage. The post-operative care decisions may initially bederived from traditionally known responses that doctors would normallyrecommend. Once additional data becomes available, say from aggregatingtypes of post-operative care from other facilities, or from analyzingnew types of care from literature or from research on new surgicaldevices, the decision can be updated by the cloud system. The decisiontree may be displayable at a surgical hub and in a graphical form.

In using this decision tree, feedback can be provided for each node tostate how effective the current solutions are. The data may be inputtedbased on whatever feedback patients may provide. A doctor or data adminneed not perform any analysis at the time, but the cloud system canaggregate all of the data and observe what trends may arise. Feedbackcan then be provided to update the decision tree.

In some aspects, the cloud system may incorporate operative data &device performance to propose post-operative monitoring & activities.For example, various patient measures may change what decisions inpost-operative care should be taken. These measurements can include butare not limited to: (a) blood pressure; (b) low hematocrit; (c) PTT(partial thromboplastin time); (d) INR (international normalized ratio);(e) Oxygen saturation; (f) Ventilation changes; and (g) X-Ray data.

As another example, anesthesia protocol can dictate what post-operativedecisions should be taken. This may account for: (a) any fluidsadministered; (b) Anesthesia time; and (3) Medications, as somenon-limiting examples.

As another example, the types of medications may also play a role. Theapplication of Warfarin is one notable example. A patientpost-operatively has abnormal PTT and INR, for example. Because thepatient is on Warfarin, potential treatments could include vitamin K,factor 7, or the delivery of plasma (fpp). Plavix can be anotherexample. A patient post-operatively has abnormal PTT and INR. Becausepatient is on Plavix, potential treatments for Warfarin would beineffective. Deliver platelets instead may be the suggestion in thedecision tree.

As a fourth example, post-operative instructions may be provided thatare dependent on the type of procedure. Some non-limiting examplesinclude colorectal time to solid food (motility); and (b) time tophysical activity & PT. These varying decisions can be reflected in thedecision tree, and all of the types of branching decisions may be storedin the cloud system and updated when additional data is gained from anyconnected facility.

FIG. 189 provides various examples of how some data may be used asvariables in deciding how the post-operative decision tree may branchout. As shown, some factors 7802 may include the parameters used insurgical devices, such as the force to fire (FTF) used in an operation,or the force to close (FTC) used in a surgical device. Graph 7800 showsa visual depiction of how the FTC and FTF curves may interrelate withone another. Other factors include compression rate, wait time, andstaple adaptability. Based on some of these variables, a type ofpost-operative care should be adjusted. In this case, a multi-factoredanalysis is applied, which may be too complex to calculate or modifywithout the aid of the processing power of a system like the cloudsystem. This example suggests that a decision tree 7804 provided by thecloud system can be more than a simple two dimensional decision tree. Toaccount for multiple variables to make a single decision, the decisiontree generated by the cloud may be visually available for perhaps just aportion, and the ultimate conclusion may have to be displayed without afull display of all of the other branches that were not considered. Thechart 7806 may be an example of providing additional information of howto respond within the decision tree.

Adaptive Control Program Updates for Surgical Devices

Modular devices include the modules (as described in connection withFIGS. 3 and 9 , for example) that are receivable within a surgical huband the surgical devices or instruments that can be connected to thevarious modules. The modular devices include, for example, intelligentsurgical instruments, medical imaging devices, suction/irrigationdevices, smoke evacuators, energy generators, ventilators, andinsufflators. Various operations of the modular devices described hereincan be controlled by one or more control algorithms. The controlalgorithms can be executed on the modular device itself, on the surgicalhub to which the particular modular device is paired, or on both themodular device and the surgical hub (e.g., via a distributed computingarchitecture). In some exemplifications, the modular devices' controlalgorithms control the devices based on data sensed by the modulardevice itself (i.e., by sensors in, on, or connected to the modulardevice). This data can be related to the patient being operated on(e.g., tissue properties or insufflation pressure) or the modular deviceitself (e.g., the rate at which a knife is being advanced, motorcurrent, or energy levels). For example, a control algorithm for asurgical stapling and cutting instrument can control the rate at whichthe instrument's motor drives its knife through tissue according toresistance encountered by the knife as it advances.

Although an “intelligent” device including control algorithms thatrespond to sensed data can be an improvement over a “dumb” device thatoperates without accounting for sensed data, if the device's controlprogram does not adapt or update over time in response to collecteddata, then the devices may continue to repeat errors or otherwiseperform suboptimally. One solution includes transmitting operationaldata collected by the modular devices in combination with the outcomesof each procedure (or step thereof) to an analytics system. In oneexemplification, the procedural outcomes can be inferred by asituational awareness system of a surgical hub to which the modulardevices are paired, as described in U.S. patent application Ser. No.15/940,654, entitled SURGICAL HUB SITUATIONAL AWARENESS, which is hereinincorporated by reference in its entirety. The analytics system cananalyze the data aggregated from a set of modular devices or aparticular type of modular device to determine under what conditions thecontrol programs of the analyzed modular devices are controlling themodular devices suboptimally (i.e., if there are repeated faults orerrors in the control program or if an alternative algorithm performs ina superior manner) or under what conditions medical personnel areutilizing the modular devices suboptimally. The analytics system canthen generate an update to fix or improve the modular devices' controlprograms. Different types of modular devices can be controlled bydifferent control programs; therefore, the control program updates canbe specific to the type of modular device that the analytics systemdetermines is performing suboptimally. The analytics system can thenpush the update to the appropriate modular devices connected to theanalytics system through the surgical hubs.

FIG. 190 illustrates a block diagram of a computer-implemented adaptivesurgical system 9060 that is configured to adaptively generate controlprogram updates for modular devices 9050, in accordance with at leastone aspect of the present disclosure. In one exemplification, thesurgical system includes a surgical hub 9000, multiple modular devices9050 communicably coupled to the surgical hub 9000, and an analyticssystem 9100 communicably coupled to the surgical hub 9000. Although asingle surgical hub 9000 is depicted, it should be noted that thesurgical system 9060 can include any number of surgical hubs 9000, whichcan be connected to form a network of surgical hubs 9000 that arecommunicably coupled to the analytics system 9010. In oneexemplification, the surgical hub 9000 includes a processor 9010 coupledto a memory 9020 for executing instructions stored thereon and a datarelay interface 9030 through which data is transmitted to the analyticssystem 9100. In one exemplification, the surgical hub 9000 furtherincludes a user interface 9090 having an input device 9092 (e.g., acapacitive touchscreen or a keyboard) for receiving inputs from a userand an output device 9094 (e.g., a display screen) for providing outputsto a user. Outputs can include data from a query input by the user,suggestions for products or mixes of products to use in a givenprocedure, and/or instructions for actions to be carried out before,during, or after surgical procedures. The surgical hub 9000 furtherincludes an interface 9040 for communicably coupling the modular devices9050 to the surgical hub 9000. In one aspect, the interface 9040includes a transceiver that is communicably connectable to the modulardevice 9050 via a wireless communication protocol. The modular devices9050 can include, for example, surgical stapling and cuttinginstruments, electrosurgical instruments, ultrasonic instruments,insufflators, respirators, and display screens. In one exemplification,the surgical hub 9000 can further be communicably coupled to one or morepatient monitoring devices 9052, such as EKG monitors or BP monitors. Inanother exemplification, the surgical hub 9000 can further becommunicably coupled to one or more databases 9054 or external computersystems, such as an EMR database of the medical facility at which thesurgical hub 9000 is located.

When the modular devices 9050 are connected to the surgical hub 9000,the surgical hub 9000 can sense or receive perioperative data from themodular devices 9050 and then associate the received perioperative datawith surgical procedural outcome data. The perioperative data indicateshow the modular devices 9050 were controlled during the course of asurgical procedure. The procedural outcome data includes data associatedwith a result from the surgical procedure (or a step thereof), which caninclude whether the surgical procedure (or a step thereof) had apositive or negative outcome. For example, the outcome data couldinclude whether a patient suffered from postoperative complications froma particular procedure or whether there was leakage (e.g., bleeding orair leakage) at a particular staple or incision line. The surgical hub9000 can obtain the surgical procedural outcome data by receiving thedata from an external source (e.g., from an EMR database 9054), bydirectly detecting the outcome (e.g., via one of the connected modulardevices 9050), or inferring the occurrence of the outcomes through asituational awareness system. For example, data regarding postoperativecomplications could be retrieved from an EMR database 9054 and dataregarding staple or incision line leakages could be directly detected orinferred by a situational awareness system. The surgical proceduraloutcome data can be inferred by a situational awareness system from datareceived from a variety of data sources, including the modular devices9050 themselves, the patient monitoring device 9052, and the databases9054 to which the surgical hub 9000 is connected.

The surgical hub 9000 can transmit the associated modular device 9050data and outcome data to the analytics system 9100 for processingthereon. By transmitting both the perioperative data indicating how themodular devices 9050 are controlled and the procedural outcome data, theanalytics system 9100 can correlate the different manners of controllingthe modular devices 9050 with surgical outcomes for the particularprocedure type. In one exemplification, the analytics system 9100includes a network of analytics servers 9070 that are configured toreceive data from the surgical hubs 9000. Each of the analytics servers9070 can include a memory and a processor coupled to the memory that isexecuting instructions stored thereon to analyze the received data. Insome exemplifications, the analytics servers 9070 are connected in adistributed computing architecture and/or utilize a cloud computingarchitecture. Based on this paired data, the analytics system 9100 canthen learn optimal or preferred operating parameters for the varioustypes of modular devices 9050, generate adjustments to the controlprograms of the modular devices 9050 in the field, and then transmit (or“push”) updates to the modular devices' 9050 control programs.

Additional detail regarding the computer-implemented interactivesurgical system 9060, including the surgical hub 9000 and variousmodular devices 9050 connectable thereto, are described in connectionwith FIGS. 9-10 .

FIG. 191 illustrates a logic flow diagram of a process 9200 for updatingthe control program of a modular device 9050, in accordance with atleast one aspect of the present disclosure. In the following descriptionof the process 9200, reference should also be made to FIG. 190 . Theprocess 9200 can be executed by, for example, one or more processors ofthe analytics servers 9070 of the analytics system 9100. In oneexemplification, the analytics system 9100 can be a cloud computingsystem. For economy, the following description of the process 9200 willbe described as being executed by the analytics system 9100; however, itshould be understood that the analytics system 9100 includesprocessor(s) and/or control circuit(s) that are executing the describesteps of the process 9200.

The analytics system 9100 receives 9202 modular device 9050perioperative data and surgical procedural outcome data from one or moreof the surgical hubs 9000 that are communicably connected to theanalytics system 9100. The perioperative data includes preoperativedata, intraoperative data, and/or postoperative data detected by amodular device 9050 in association with a given surgical procedure. Formodular devices 9050 or particular functions of modular devices 9050that are manually controlled, the perioperative data indicates themanner in which a surgical staff member operated the modular devices9050. For modular devices 9050 or particular functions of modulardevices 9050 that are controlled by the modular devices' controlprograms, the perioperative data indicates the manner in which thecontrol programs operated the modular devices 9050. The manner in whichthe modular devices 9050 function under particular sets of conditions(either due to manual control or control by the modular devices' 9050control programs) can be referred to as the “operational behavior”exhibited by the modular device 9050. The modular device 9050perioperative data includes data regarding the state of the modulardevice 9050 (e.g., the force to fire or force to close for a surgicalstapling and cutting instrument or the power output for anelectrosurgical or ultrasonic instrument), tissue data measured by themodular device 9050 (e.g., impedance, thickness, or stiffness), andother data that can be detected by a modular device 9050. Theperioperative data indicates the manner in which the modular devices9050 were programmed to operate or were manually controlled during thecourse of a surgical procedure because it indicates how the modulardevices 9050 functioned in response to various detected conditions.

The surgical procedural outcome data includes data pertaining to anoverall outcome of a surgical procedure (e.g., whether there was acomplication during the surgical procedure) or data pertaining to anoutcome of a specific step within a surgical procedure (e.g., whether aparticular staple line bled or leaked). The procedural outcome data can,for example, be directly detected by the modular devices 9050 and/orsurgical hub 9000 (e.g., a medical imaging device can visualize ordetect bleeding), determined or inferred by a situational awarenesssystem of the surgical hub 9000 as described in U.S. patent applicationSer. No. 15/940,654, or retrieved from a database 9054 (e.g., an EMRdatabase) by the surgical hub 9000 or the analytics system 9100. Theprocedural outcome data can include whether each outcome represented bythe data was a positive or negative result. Whether each outcome waspositive or negative can be determined by the modular devices 9050themselves and included in the perioperative data transmitted to thesurgical hubs 9000 or determined or inferred by the surgical hubs 9000from the received perioperative data. For example, the proceduraloutcome data for a staple line that bled could include that the bleedingrepresented a negative outcome. Similarly, the procedural outcome datafor a staple line that did not bleed could include that the lack ofbleeding represented a positive outcome. In another exemplification, theanalytics system 9100 can be configured to determine whether aprocedural outcome is a positive or negative outcome based upon thereceived procedural outcome data. In some exemplifications, correlatingthe modular device 9050 data to positive or negative procedural outcomesallows the analytics system 9100 to determine whether a control programupdate should be generated 9208.

Upon the analytics system 9100 receiving 9202 the data, the analyticssystem 9100 analyzes the modular device 9050 and procedural outcome datato determine 9204 whether the modular devices 9050 are being utilizedsuboptimally in connection with the particular procedure or theparticular step of the procedure. A modular device 9050 can becontrolled suboptimally if the particular manner in which the modulardevice 9050 is being controlled is repeatedly causing an error or if analternative manner of controlling the modular device 9050 is superiorunder the same conditions. The analytics system 9100 can thus determinewhether a modular device 9050 is being controlled suboptimally (eithermanually or by its control program) by comparing the rate of positiveand/or negative outcomes produced by the modular device 9050 relative toset thresholds or the performance of other modular devices 9050 of thesame type.

For example, the analytics system 9100 can determine whether a type ofmodular device 9050 is being operated suboptimally if the rate ofnegative procedural outcomes produced by the modular device 9050 under aparticular set of conditions in association with a particularoperational behavior exceeds an average or threshold level. As aspecific example, the analytics system 9100 can analyze 9204 whether acontrol program for a surgical stapling instrument that dictates aparticular force to fire (or ranges of forces to fire) is suboptimal fora particular tissue thickness and tissue type. If the analytics system9100 determines that the instrument generates an abnormally high rate ofleaky staple lines when fired at the particular force (e.g., causing thestaples to be malformed, not fully penetrate the tissue, or tear thetissue) relative to an average or threshold staple line leakage rate,then the analytics system 9100 can determine that the control programfor the surgical stapling instrument is performing suboptimally giventhe tissue conditions.

As another example, the analytics system 9100 can determine whether atype of modular device 9050 is being operated suboptimally if the rateof positive outcomes produced by an alternative manner of control undera particular set of conditions in association with a particularoperational behavior exceeds the rate of positive outcomes generated bythe analyzed manner of control under the same conditions. In otherwords, if one subpopulation of the type of modular device 9050 exhibitsa first operational behavior under a certain set of conditions and asecond subpopulation of the same type of modular device 9050 exhibits asecond operational behavior under the same set of conditions, then theanalytics system 9100 can determine whether to update the controlprograms of the modular devices 9050 according to whether the first orsecond operational behavior is more highly correlated to a positiveprocedural outcome. As a specific example, the analytics system 9100 cananalyze 9204 whether a control program for an RF electrosurgical orultrasonic instrument that dictates a particular energy level issuboptimal for a particular tissue type and environmental conditions. Ifthe analytics system 9100 determines that a first energy level given aset of tissue conditions and environmental conditions (e.g., theinstrument being located in a liquid-filled environment, as in anarthroscopic procedure) produces a lower rate of hemostasis than asecond energy level, then the analytics system 9100 can determine thatthe control program for the electrosurgical or ultrasonic instrumentdictating the first energy level is performing suboptimally for thegiven tissue and environmental conditions.

After analyzing 9204 the data, the analytics system 9100 determines 9206whether to update the control program. If the analytics system 9100determines that the modular device 9050 is not being controlledsuboptimally, then the process 9200 continues along the NO branch andthe analytics system 9100 continues analyzing 9204 received 9202 data,as described above. If the analytics system 9100 determines that themodular device 9050 is being controlling suboptimally, then the process9200 continues along the YES branch and the analytics system 9100generates 9208 a control program update. The generated 9208 controlprogram update includes, for example, a new version of the controlprogram for the particular type of modular device 9050 to overwrite theprior version or a patch that partially overwrites or supplements theprior version.

The type of control program update that is generated 9208 by theanalytics system 9100 depends upon the particular suboptimal behaviorexhibited by the modular device 9050 that is identified by the analyticssystem 9100. For example, if the analytics system 9100 determines that aparticular force to fire a surgical stapling instrument results in anincreased rate of leaking staple lines, then the analytics system 9100can generate 9208 a control program update that adjusts the force tofire from a first value to a second value that corresponds to a higherrate of non-leaking staple lines or a lower rate of leaking staplelines. As another example, if the analytics system 9100 determines thata particular energy level for an electrosurgical or ultrasonicinstrument produces a low rate of hemostasis when the instrument is usedin a liquid-filled environment (e.g., due to the energy dissipatingeffects of the liquid), then the analytics system 9100 can generated9208 a control program update that adjusts the energy level of theinstrument when it is utilized in surgical procedures where theinstrument will be immersed in liquid.

The type of control program update that is generated 9208 by theanalytics system 9100 also depends upon whether the suboptimal behaviorexhibited by the modular device 9050 is caused by manual control orcontrol by the control program of the modular device 9050. If thesuboptimal behavior is caused by manual control, the control programupdate can be configured to provide warnings, recommendations, orfeedback to the users based upon the manner in which they are operatingthe modular devices 9050. Alternatively, the control program update canchange the manually controlled operation of the modular device 9050 toan operation that is controlled by the control program of the modulardevice 9050. The control program update may or may not permit the userto override the control program's control of the particular function. Inone exemplification, if the analytics system 9100 determines 9204 thatsurgeons are manually setting an RF electrosurgical instrument to asuboptimal energy level for a particular tissue type or procedure type,then the analytics system 9100 can generate 9208 a control programupdate that provides an alert (e.g., on the surgical hub 9000 or the RFelectrosurgical instrument itself) recommending that the energy level bechanged. In another exemplification, the generated 9208 control programupdate can automatically set the energy level to a default orrecommended level given the particular detected circumstances, whichcould then be changed as desired by the medical facility staff. In yetanother exemplification, the generated 9208 control program update canautomatically set the energy level to a set level determined by theanalytics system 9100 and not permit the medical facility staff tochange the energy level. If the suboptimal behavior is caused by thecontrol program of the modular device 9050, then the control programupdate can alter how the control program functions under the particularset of circumstances that the control program is performing suboptimallyunder.

Once the control program update has been generated 9208 by the analyticssystem 9100, the analytics system 9100 then transmits 9210 or pushes thecontrol program update to all of the modular devices 9050 of therelevant type that are connected to the analytics system 9100. Themodular devices 9050 can be connected to the analytics system 9100through the surgical hubs 900, for example. In one exemplification, thesurgical hubs 9000 are configured to download the control programupdates for the various types of modular devices 9050 from the analyticssystem 9100 each time an update is generated 9208 thereby. When themodular devices 9050 subsequently connect to or pair with a surgical hub9000, the modular devices 9050 then automatically download any controlprogram updates therefrom. In one exemplification, the analytics system9100 can thereafter continue receiving 9202 and analyzing 9204 data fromthe modular devices 9050, as described above.

In one exemplification, instead of the modular devices 9050 transmittingrecorded data to a surgical hub 9000 to which the modular devices 9050are connected, the modular devices 9050 are configured to record theperioperative data and the procedural outcome data on a memory of themodular device 9050. The data can be stored for indefinitely or untilthe data is downloaded from the modular devices 9050. This allows thedata to be retrieved at a later time. For example, the modular devices9050 could be returned to the manufacturer after they are utilized in asurgical procedure. The manufacturer could then download the data fromthe modular devices 9050 and then analyze the data as described above todetermine whether a control program update should be generated for themodular devices 9050. In one exemplification, the data could be uploadedto an analytics system 9100 for analysis, as described above. Theanalytics system 9100 could then generate update control programsaccording to the recorded data and then either incorporate that updatein future manufactured product or push the update to modular devices9050 currently in the field.

In order to assist in the understanding of the process 9200 illustratedin FIG. 191 and the other concepts discussed above, FIG. 192 illustratesa diagram of an illustrative analytics system 9100 updating a surgicalinstrument control program, in accordance with at least one aspect ofthe present disclosure. In one exemplification, a surgical hub 9000 ornetwork of surgical hubs 9000 is communicably coupled to an analyticssystem 9100, as illustrated above in FIG. 190 . The analytics system9100 is configured to filter and analyze modular device 9050 dataassociated with surgical procedural outcome data to determine whetheradjustments need to be made to the control programs of the modulardevices 9050. The analytics system 9100 can then push updates to themodular devices 9050 through the surgical hubs 9000, as necessary. Inthe depicted exemplification, the analytics system 9100 comprises acloud computing architecture. The modular device 9050 perioperative datareceived by the surgical 9000 hubs from their paired modular devices9050 can include, for example, force to fire (i.e., the force requiredto advance a cutting member of a surgical stapling instrument through atissue), force to close (i.e., the force required to clamp the jaws of asurgical stapling instrument on a tissue), the power algorithm (i.e.,change in power over time of electrosurgical or ultrasonic instrumentsin response to the internal states of the instrument and/or tissueconditions), tissue properties (e.g., impedance, thickness, stiffness,etc.), tissue gap (i.e., the thickness of the tissue), and closure rate(i.e., the rate at which the jaws of the instrument clamped shut). Itshould be noted that the modular device 9050 data that is transmitted tothe analytics system 9100 is not limited to a single type of data andcan include multiple different data types paired with procedural outcomedata. The procedural outcome data for a surgical procedure (or stepthereof) can include, for example, whether there was bleeding at thesurgical site, whether there was air or fluid leakage at the surgicalsite, and whether the staples of a particular staple line were formedproperly. The procedural outcome data can further include or beassociated with a positive or negative outcome, as determined by thesurgical hub 9000 or the analytics system 9100, for example. The modulardevice 9050 data and the procedural outcome data corresponding to themodular device 9050 perioperative data can be paired together orotherwise associated with each other when they are uploaded to theanalytics system 9100 so that the analytics system 9100 is able torecognize trends in procedural outcomes based on the underlying data ofthe modular devices 9050 that produced each particular outcome. In otherwords, the analytics system 9100 can aggregate the modular device 9050data and the procedural outcome data to search for trends or patterns inthe underlying device modular data 9050 that can indicate adjustmentsthat can be made to the modular devices' 9050 control programs.

In the depicted exemplification, the analytics system 9100 executing theprocess 9200 described in connection with FIG. 190 is receiving 9202modular device 9050 data and procedural outcome data. When transmittedto the analytics system 9100, the procedural outcome data can beassociated or paired with the modular device 9050 data corresponding tothe operation of the modular device 9050 that caused the particularprocedural outcome. The modular device 9050 perioperative data andcorresponding procedural outcome data can be referred to as a data pair.The data is depicted as including a first group 9212 of data associatedwith successful procedural outcomes and a second group 9214 of dataassociated with negative procedural outcomes. For this particularexemplification, a subset of the data 9212, 9214 received 9202 by theanalytics system 9100 is highlighted to further elucidate the conceptsdiscussed herein.

For a first data pair 9212 a, the modular device 9050 data includes theforce to close (FTC) over time, the force to fire (FTF) over time, thetissue type (parenchyma), the tissue conditions (the tissue is from apatient suffering from emphysema and had been subject to radiation),what number firing this was for the instrument (third), an anonymizedtime stamp (to protect patient confidentiality while still allowing theanalytics system to calculate elapsed time between firings and othersuch metrics), and an anonymized patient identifier (002). Theprocedural outcome data includes data indicating that there was nobleeding, which corresponds to a successful outcome (i.e., a successfulfiring of the surgical stapling instrument). For a second data pair 9212b, the modular device 9050 data includes the wait time prior theinstrument being fired (which corresponds to the first firing of theinstrument), the FTC over time, the FTF over time (which indicates thatthere was a force spike near the end of the firing stroke), the tissuetype (1.1 mm vessel), the tissue conditions (the tissue had been subjectto radiation), what number firing this was for the instrument (first),an anonymized time stamp, and an anonymized patient identifier (002).The procedural outcome data includes data indicating that there was aleak, which corresponds to a negative outcome (i.e., a failed firing ofthe surgical stapling instrument). For a third data pair 9212 c, themodular device 9050 data includes the wait time prior the instrumentbeing fired (which corresponds to the first firing of the instrument),the FTC over time, the FTF over time, the tissue type (1.8 mm vessel),the tissue conditions (no notable conditions), what number firing thiswas for the instrument (first), an anonymized time stamp, and ananonymized patient identifier (012). The procedural outcome dataincludes data indicating that there was a leak, which corresponds to anegative outcome (i.e., a failed firing of the surgical staplinginstrument). It should be noted again that this data is intended solelyfor illustrative purposes to assist in the understanding of the conceptsdiscussed herein and should not be interpreted to limit the data that isreceived and/or analyzed by the analytics system 9100 to generatecontrol program updates.

When the analytics system 9100 receives 9202 perioperative data from thecommunicably connected surgical hubs 9000, the analytics system 9100proceeds to aggregate and/or store the data according to the proceduretype (or a step thereof) associated with the data, the type of themodular device 9050 that generated the data, and other such categories.By collating the data accordingly, the analytics system 9100 can analyzethe data set to identify correlations between particular ways ofcontrolling each particular type of modular device 9050 and positive ornegative procedural outcomes. Based upon whether a particular manner ofcontrolling a modular device 9050 correlates to positive or negativeprocedural outcomes, the analytics system 9100 can determine 9204whether the control program for the type of modular device 9050 shouldbe updated.

For this particular exemplification, the analytics system 9100 performsa first analysis 9216 a of the data set by analyzing the peak FTF 9213(i.e., the maximum FTF for each particular firing of a surgical staplinginstrument) relative to the number of firings 9211 for each peak FTFvalue. In this exemplary case, the analytics system 9100 can determinethat there is no particular correlation between the peak FTF 9213 andthe occurrence of positive or negative outcomes for the particular dataset. In other words, there are not distinct distributions for the peakFTF 9213 for positive and negative outcomes. As there is no particularcorrelation between peak FTF 9213 and positive or negative outcomes, theanalytics system 9100 would thus determine that a control program updateto address this variable is not necessary. Further, the analytics system9100 performs a second analysis 9216 b of the data set by analyzing thewait time 9215 prior to the instrument being fired relative to thenumber of firings 9211. For this particular analysis 9216 b, theanalytics system 9100 can determine that there is a distinct negativeoutcome distribution 9217 and a positive outcome distribution 9219. Inthis exemplary case, the negative outcome distribution 9217 has a meanof 4 seconds and the positive outcome distribution has a mean of 11seconds. Thus, the analytics system 9100 can determine that there is acorrelation between the wait time 9215 and the type of outcome for thissurgical procedure step. Namely, the negative outcome distribution 9217indicates that there is a relatively large rate of negative outcomes forwait times of 4 seconds or less. Based on this analysis 9216 bdemonstrating that there is a large divergence between the negativeoutcome distribution 9217 and the positive outcome distribution 9219,the analytics system 9100 can then determine 9204 that a control programupdate should be generated 9208.

Once the analytics system 9100 analyzes the data set and determines 9204that an adjustment to the control program of the particular moduledevice 9050 that is the subject of the data set would improve theperformance of the modular device 9050, the analytics system 9100 thengenerates 9208 a control program update accordingly. In this exemplarycase, the analytics system 9100 can determine based on the analysis 9216b of the data set that a control program update 9218 recommending a waittime of more than 5 seconds would prevent 90% of the distribution of thenegative outcomes with a 95% confidence interval. Alternatively, theanalytics system 9100 can determine based on the analysis 9216 b of thedata set that a control program update 9218 recommending a wait time ofmore than 5 seconds would result in the rate of positive outcomes beinggreater than the rate of negative outcomes. The analytics system 9100could thus determine that the particular type of surgical instrumentshould wait more than 5 seconds before being fired under the particulartissue conditions so that negative outcomes are less common thanpositive outcomes. Based on either or both of these constraints forgenerating 9208 a control program update that the analytics system 9100determines are satisfied by the analysis 9216 b, the analytics system9100 can generate 9208 a control program update 9218 for the surgicalinstrument that causes the surgical instrument, under the givencircumstances, to either impose a 5 second or longer wait time beforethe particular surgical instrument can be fired or causes the surgicalinstrument to display a warning or recommendation to the user thatindicates to the user that the user should wait at least 5 secondsbefore firing the instrument. Various other constraints can be utilizedby the analytics system 9100 in determining whether to generate 9208 acontrol program update, such as whether a control program update wouldreduce the rate of negative outcomes by a certain percentage or whethera control program update maximizes the rate of positive outcomes.

After the control program update 9218 is generated 9208, the analyticssystem 9100 then transmits 9210 the control program update 9218 for theappropriate type of modular devices 9050 to the surgical hubs 9000. Inone exemplification, when a modular device 9050 that corresponds to thecontrol program update 9218 is next connected to a surgical hub 9000that has downloaded the control program update 9218, the modular device9050 then automatically downloads the update 9218. In anotherexemplification, the surgical hub 9000 controls the modular device 9050according to the control program update 9218, rather than the controlprogram update 9218 being transmitted directly to the modular device9050 itself.

In one aspect, the surgical system 9060 is configured to push downverification of software parameters and updates if modular devices 9050are detected to be out of date in the surgical hub 9000 data stream.FIG. 193 illustrates a diagram of an analytics system 9100 pushing anupdate to a modular device 9050 through a surgical hub 9000, inaccordance with at least one aspect of the present disclosure. In oneexemplification, the analytics system 9000 is configured to transmit agenerated control program update for a particular type of modular device9050 to a surgical hub 9000. In one aspect, each time a modular device9050 connects to a surgical hub 9000, the modular device 9050 determineswhether there is an updated version of its control program on orotherwise accessible via the surgical hub 9000. If the surgical hub 9000does have an updated control program (or the updated control program isotherwise available from the analytics system 9100) for the particulartype of modular device 9050, then the modular device 9050 downloads thecontrol program update therefrom.

In one exemplification, any data set being transmitted to the analyticssystems 9100 includes a unique ID for the surgical hub 9000 and thecurrent version of its control program or operating system. In oneexemplification, any data set being sent to the analytics systems 9100includes a unique ID for the modular device 9050 and the current versionof its control program or operating system. The unique ID of thesurgical hub 9000 and/or modular device 9050 being associated with theuploaded data allows the analytics system 9100 to determine whether thedata corresponds to the most recent version of the control program. Theanalytics system 9100 could, for example, elect to discount (or ignore)data generated by a modular device 9050 or surgical hub 9000 beingcontrolled by an out of date control program and/or cause the updatedversion of the control program to be pushed to the modular device 9050or surgical hub 9000.

In one exemplification, the operating versions of all modular devices9050 the surgical hub 9000 has updated control software for could alsobe included in a surgical hub 9000 status data block that is transmittedto the analytics system 9100 on a periodic basis. If the analyticssystem 9100 identifies that the operating versions of the controlprograms of the surgical hub 9100 and/or any of the connectable modulardevices 9050 are out of date, the analytics system 9100 could push themost recent revision of the relevant control program to the surgical hub9000.

In one exemplification, the surgical hub 9000 and/or modular devices9050 can be configured to automatically download any software updates.In another exemplification, the surgical hub 9000 and/or modular devices9050 can be configured to provide a prompt for the user to ask at thenext setup step (e.g., between surgical procedures) if the user wants toupdate the out of date control program(s). In another exemplification,the surgical hub 9000 could be programmable by the user to never allowupdates or only allow updates of the modular devices 9050 and not thesurgical hub 9000 itself.

Adaptive Control Program Updates for Surgical Hubs

As with the modular devices 9050 described above, the surgical hubs 9000can likewise include control programs that control the variousoperations of the surgical hub 9000 during the course of a surgicalprocedure. If the surgical hubs' 9000 control programs do not adapt overtime in response to collected data, then the surgical hubs 9000 maycontinue to repeat errors, not provide warnings or recommendations tothe surgical staff based on learned information, and not adjust to thesurgical staff's preferences. One solution includes transmittingoperational data from the surgical hubs 9000 that indicates how thesurgical hubs 9000 are being utilized or controlled during the course ofa surgical procedure to an analytics system 9100. The analytics system9100 can then analyze the data aggregated from the network of surgicalhubs 9000 connected to the analytics system 9100 to determine if aparticular manner of operating the surgical hubs 9000 corresponds toimproved patient outcomes or is otherwise preferred across thepopulation of the surgical hubs 9000. In one exemplification, if aparticular manner in which the surgical hubs 9000 are operated satisfiesa defined condition or set of conditions, then the analytics system 9100can determine that this particular manner should be implemented acrossthe network of surgical hubs 9000. The analytics system 9100 cangenerate an update to the surgical hubs' 9000 control program to fix orimprove the control program and then push the update to the surgicalhubs 9000 so that the improvement is shared across every surgical hub9000 that is connected to the analytics system 9100. For example, if athreshold number of the surgical hubs 9000 are controlled in aparticular manner and/or if a particular manner of controlling thesurgical hubs 9000 correlates to an improvement in the surgicalprocedure outcomes that exceeds a threshold level, then the analyticssystem 9100 can generate a control program update that controls thesurgical hubs 9000 in a manner corresponding to the preferred orimproved manner of control. The control program update can then bepushed to the surgical hubs 9000.

In one exemplification, an analytics system 9100 is configured togenerate and push control program updates to surgical hubs 9000 in thefield based on perioperative data relating to the manner in which thesurgical hubs 9000 are controlled or utilized. In other words, thesurgical hubs 9000 can be updated with improved decision-makingabilities according to data generated from the hub network. In oneaspect, external and perioperative data is collected by an analyticssystem. The data is then analyzed to generate a control update toimprove the performance of the surgical hubs 9000. The analytics system9100 can analyze the data aggregated from the surgical hubs 9000 todetermine the preferred manner for the surgical hubs 9000 to operate,under what conditions the surgical hubs' 9000 control programs arecontrolling the surgical hubs 9000 suboptimally (i.e., if there arerepeated faults or errors in the control program or if an alternativealgorithm performs in a superior manner), or under what conditionsmedical personnel are utilizing the surgical hubs 9000 suboptimally. Theanalytics system 9100 can then push the update to the surgical hubs 9000connected thereto.

FIG. 194 illustrates a diagram of a computer-implemented adaptivesurgical system 9060 that is configured to adaptively generate controlprogram updates for surgical hubs 9000, in accordance with at least oneaspect of the present disclosure. The surgical system 9060 includesseveral surgical hubs 9000 that are communicably coupled to theanalytics system 9100. Subpopulations of surgical hubs 9000 (each ofwhich can include individual surgical hubs 9000 or groups of surgicalhubs 9000) within the overall population connected to the analyticssystem 9100 can exhibit different operational behaviors during thecourse of a surgical procedure. The differences in operational behaviorbetween groups of surgical hubs 9000 within the population can resultfrom the surgical hubs 9000 running different versions of their controlprogram, by the surgical hubs' 9000 control programs being customized orprogrammed differently by local surgical staff, or by the local surgicalstaff manually controlling the surgical hubs 9000 differently. In thedepicted example, the population of surgical hubs 9000 includes a firstsubpopulation 9312 that is exhibiting a first operational behavior and asecond subpopulation 9314 that is exhibiting a second operationalbehavior for a particular task. Although the surgical hubs 9000 aredivided into a pair of subpopulations 9312, 9314 in this particularexample, there is no practical limit to the number of differentbehaviors exhibited within the population of surgical hubs 9000. Thetasks that the surgical hubs 9000 can be executing include, for example,controlling a surgical instrument or analyzing a dataset in a particularmanner.

The surgical hubs 9000 can be configured to transmit perioperative datapertaining to the operational behavior of the surgical hubs 9000 to theanalytics system 9100. The perioperative data can include preoperativedata, intraoperative data, and postoperative data. The preoperative datacan include, for example, patient-specific information, such asdemographics, health history, preexisting conditions, preoperativeworkup, medication history (i.e., medications currently and previouslytaken), genetic data (e.g., SNPs or gene expression data), EMR data,advanced imaging data (e.g., MRI, CT, or PET), metabolomics, andmicrobiome. Various additional types of patient-specific informationthat can be utilized by the analytics system 9100 are described by U.S.Pat. No. 9,250,172, U.S. patent application Ser. No. 13/631,095, U.S.patent application Ser. No. 13/828,809, and U.S. Pat. No. 8,476,227,each of which is incorporated by reference herein to the extent thatthey describe patient-specific information. The preoperative data canalso include, for example, operating theater-specific information, suchas geographic information, hospital location, operating theaterlocation, operative staff performing the surgical procedure, theresponsible surgeon, the number and type of modular devices 9050 and/orother surgical equipment that could potentially be used in theparticular surgical procedure, the number and type of modular devices9050 and/or other surgical equipment that are anticipated to be used inthe particular surgical procedure, patient identification information,and the type of procedure being performed.

The intraoperative data can include, for example, modular device 9050utilization (e.g., the number of firings by a surgical staplinginstrument, the number of firings by an RF electrosurgical instrument oran ultrasonic instrument, or the number and types of stapler cartridgesutilized), operating parameter data of the modular devices 9050 (e.g.,the FTF curve for a surgical stapling instrument, a FTC curve for asurgical stapling instrument, the energy output of a generator, theinternal pressure or pressure differential of a smoke evacuator),unexpected modular device 9050 utilization (i.e., the detection of theutilization of a modular device that is nonstandard for the proceduretype), adjunctive therapies administered to the patient, and utilizationof equipment other than the modular devices 9050 (e.g., sealants toaddress leaks). The intraoperative data can also include, for example,detectable misuse of a modular device 9050 and detectable off-label useof a modular device 9050.

The postoperative data can include, for example, a flag if the patientdoes not leave the operating theater and/or is sent for nonstandardpostoperative care (e.g., a patient undergoing a routine bariatricprocedure is sent to the ICU after the procedure), a postoperativepatient evaluation relating to the surgical procedure (e.g., datarelating to a spirometric performance after a thoracic surgery or datarelating to a staple line leakage after bowel or bariatric procedures),data related to postoperative complications (e.g., transfusions or airleaks), or the patient's length of stay in the medical facility afterthe procedure. Because hospitals are increasingly being graded onreadmission rates, complication rates, average length of stay, and othersuch surgical quality metrics, the postoperative data sources can bemonitored by the analytics system 9100 either alone or in combinationwith surgical procedural outcome data (discussed below) to assess andinstitute updates to the controls programs of the surgical hubs 9000and/or modular devices 9050.

In some exemplifications, the intraoperative and/or postoperative datacan further include data pertaining to the outcome of each surgicalprocedure or a step of the surgical procedure. The surgical proceduraloutcome data can include whether a particular procedure or a particularstep of a procedure had a positive or negative outcome. In someexemplifications, the surgical procedural outcome data can includeprocedure step and/or time stamped images of modular device 9050performance, a flag indicating whether a modular device 9050 functionedproperly, notes from the medical facility staff, or a flag for poor,suboptimal, or unacceptable modular device 9050 performance. Thesurgical procedural outcome data can, for example, be directly detectedby the modular devices 9050 and/or surgical hub 9000 (e.g., a medicalimaging device can visualize or detect bleeding), determined or inferredby a situational awareness system of the surgical hub 9000 as describedin U.S. patent application Ser. No. 15/940,654, or retrieved from adatabase 9054 (e.g., an EMR database) by the surgical hub 9000 or theanalytics system 9100. In some exemplifications, perioperative dataincluding a flag indicating that a modular device 9050 failed orotherwise performed poorly during the course of a surgical procedure canbe prioritized for communication to and/or analysis by the analyticssystem 9100.

In one exemplification, the perioperative data can be assembled on aprocedure-by-procedure basis and uploaded by the surgical hubs 9000 tothe analytics system 9100 for analysis thereby. The perioperative dataindicates the manner in which the surgical hubs 9000 were programmed tooperate or were manually controlled in association with a surgicalprocedure (i.e., the operational behavior of the surgical hubs 9000)because it indicates what actions the surgical hub 9000 took in responseto various detected conditions, how the surgical hubs 9000 controlledthe modular devices 9050, and what inferences the situationally awaresurgical hubs 9000 derived from the received data. The analytics system9100 can be configured to analyze the various types and combinations ofpreoperative, intraoperative, and post-operative data to determinewhether a control program update should be generated and then push theupdate to the overall population or one or more subpopulations ofsurgical hubs 9000, as necessary.

FIG. 195 illustrates a logic flow diagram of a process 9300 for updatingthe control program of a surgical hub 9000, in accordance with at leastone aspect of the present disclosure. During the following descriptionof the process 9300, reference should also be made to FIGS. 190 and 194. The process 9200 can be executed by, for example, one or moreprocessors of the analytics servers 9070 of the analytics system 9100.In one exemplification, the analytics system 9100 can be a cloudcomputing system. For economy, the following description of the process9300 will be described as being executed by the analytics system 9100;however, it should be understood that the analytics system 9100 includesprocessor(s) and/or control circuit(s) that are executing the describesteps of the process 9300.

The analytics system 9100 executing the process 9300 receives 9302perioperative data from the surgical hubs 9000 that are communicablyconnected to the analytics system 9100. The perioperative data indicatesthe manner in which the surgical hubs 9000 are programmed to operate bytheir control programs or are controlled by the surgical staff during asurgical procedure. In some aspects, the perioperative data can includeor being transmitted to the analytics system 9100 in association withsurgical procedural outcome data. The surgical procedural outcome datacan include data pertaining to an overall outcome of a surgicalprocedure (e.g., whether there was a complication during the surgicalprocedure) or data pertaining to a specific step within a surgicalprocedure (e.g., whether a particular staple line bled or leaked).

After an analytics system 9100 executing the process 9300 has received9302 the perioperative data, the analytics system 9100 then analyzes9304 the data to determine whether an update condition has beensatisfied. In one exemplification, the update condition includes whethera threshold number or percentage of surgical hubs 9000 within thepopulation exhibit a particular operational behavior. For example, theanalytics system 9100 can determine that a control program update shouldbe generated to automatically active an energy generator at a particularstep in a type of surgical procedure when a majority of the surgicalhubs 9000 are utilized to active the energy generator at that proceduralstep. In another exemplification, the update condition includes whetherthe rate of positive procedural outcomes (or lack of negative proceduraloutcomes) correlated to a particular operational behavior exceeds athreshold value (e.g., an average rate of positive procedural outcomesfor a procedure step). For example, the analytics system 9100 candetermine that a control program update should be generated to recommendthat the energy generator be set at a particular energy level when theassociated rate of hemostasis (i.e., lack of bleeding) at that energylevel for the particular tissue type exceeds a threshold rate. Inanother exemplification, the update condition includes whether the rateof positive procedural outcomes (or lack of negative proceduraloutcomes) for a particular operational behavior is higher than the rateof positive procedural outcomes (or a lack of negative proceduraloutcomes) for related operational behaviors. In other words, if onesubpopulation of surgical hubs 9000 exhibits a first operationalbehavior under a certain set of conditions and a second subpopulation ofsurgical hubs 9000 exhibits a second operational behavior under the sameset of conditions, then the analytics system 9100 can determine whetherto update the control programs of the surgical hubs 9000 according towhether the first or second operational behavior is more highlycorrelated to a positive procedural outcome. In another exemplification,the analytics system 9100 analyzes 9304 the data to determine whethermultiple update conditions have been satisfied.

If an update condition has not been satisfied, the process 9300continues along the NO branch and the analytics system 9100 continuesreceiving 9302 and analyzing 9304 perioperative data from the surgicalhubs 9000 to monitor for the occurrence of an update condition. If anupdate condition has been satisfied, the process 9300 continues alongthe YES branch and the analytics system 9100 proceeds to generate 9308 acontrol program update. The nature of the generated 9308 control programupdate corresponds to the particular operational behavior of thesurgical hub 9000 that is identified by the analytics system 9100 astriggering the update condition. In other words, the control programupdate adds, removes, or otherwise alters functions performed by thesurgical hub 9000 so that the surgical hub 9000 operates differentlyunder the conditions that gave rise to the identified operationalbehavior. Furthermore, the type of control program update also dependsupon whether the identified operational behavior results from manualcontrol or control by the control program of the surgical hub 9000. Ifthe identified operational behavior results from manual control, thecontrol program update can be configured to provide warnings,recommendations, or feedback to the users based upon the manner in whichthey are operating the surgical hub 9000. For example, if the analyticssystem 9100 determines that taking a particular action or utilizing aparticular instrument for a step in a surgical procedure improvesoutcomes, then the analytics system 9100 can generate 9308 a controlprogram update that provides a prompt or warning to the surgical staffwhen the surgical hub 9000 determines that the designated step of thesurgical procedure is occurring or will subsequently occur.Alternatively, the control program update can change one or morefunctions of the surgical hub 9000 from being manually controllable tobeing controlled by the control program of the surgical hub 9000. Forexample, if the analytics system 9100 determines that a display of thevisualization system 108 (FIG. 2 ) is set to a particular view by thesurgical staff in a predominant number of surgical procedures at aparticular step, the analytics system 9100 can generate a controlprogram update that causes the surgical hub 9000 to automatically changethe display to that view under those conditions. If the identifiedoperational behavior results from the control program of the surgicalhub 9000, then the control program update can alter how the controlprogram functions under the set of circumstances that cause theidentified operational behavior. For example, if the analytics system9100 determines that a particular energy level for an RF electrosurgicalor ultrasonic instrument correlates to poor or negative outcomes under acertain set of conditions, then the analytics system 9100 can generate9308 a control program update that causes the surgical hub 9000 toadjust the energy level of the connected instrument to a different valuewhen the set of conditions is detected (e.g., when the surgical hub 9000determines that an arthroscopic procedure is being performed).

The analytics system 9100 then transmits 9310 the control program updateto the overall population of surgical hubs 9000 or the subpopulation(s)of surgical hubs 9000 that are performing the operational behavior thatis identified by the analytics system 9100 as triggering the updatecondition. In one exemplification, the surgical hubs 9000 are configuredto download the control program updates from the analytics system 9100each time an update is generated 9308 thereby. In one exemplification,the analytics system 9100 can thereafter continue the process 9300 ofanalyzing 9304 the data received 9302 from the surgical hubs 9000, asdescribed above.

FIG. 196 illustrates a representative implementation of the process 9300depicted in FIG. 195 . FIG. 196 illustrates a logic flow diagram of aprocess 9400 for updating the data analysis algorithm of a controlprogram of a surgical hub 9000, in accordance with at least one aspectof the present disclosure. As with the process 9300 depicted in FIG. 195, the process 9400 illustrated in FIG. 196 can, in one exemplification,be executed by the analytics system 9100. In the following descriptionof the process 9400, reference should also be made to FIG. 194 . In oneexemplification of the adaptive surgical system 9060 depicted in FIG.194 , the first surgical hub subpopulation 9312 is utilizing a firstdata analysis algorithm and the second surgical hub subpopulation 9314is utilizing a second data analysis algorithm. For example, the firstsurgical hub subpopulation 9312 can be utilizing a normal continuousprobability distribution to analyze a particular dataset, whereas thesecond surgical hub subpopulation 9314 can be utilizing a bimodaldistribution for analyzing the particular dataset. In thisexemplification, the analytics system 9100 receives 9402, 9404 theperioperative data from the first and second surgical hub subpopulations9312, 9314 corresponding to the respective data analysis algorithms. Theanalytics system 9100 then analyzes 9406 the perioperative datasets todetermine whether one of the perioperative datasets satisfies one ormore update conditions. The update conditions can include, for example,a particular analysis method being utilized by a threshold percentage(e.g., 75%) of the surgical hubs 9000 in the overall population and aparticular analysis method being correlated to positive surgicalprocedural outcomes in a threshold percentage (e.g., 50%) of cases.

In this exemplification, the analytics system 9100 determines 9408whether one of the data analysis algorithms utilized by the first andsecond surgical hub subpopulations 9312, 9314 satisfies both of theupdate conditions. If the update conditions are not satisfied, then theprocess 9400 proceeds along the NO branch and the analytics system 9100continues receiving 9402, 9404 and analyzing 9406 perioperative datafrom the first and second surgical hub subpopulations 9312, 9314. If theupdate conditions are satisfied, the process 9400 proceeds along the YESbranch and the analytics system 9100 generates 9412 a control programupdate according to which of the data analysis algorithms the analysis9406 determined satisfied the update conditions. In thisexemplification, the control program update would include causing thesurgical hub 9000 to utilize the data analysis algorithm that satisfiedthe update conditions when performing the corresponding analysis type.The analytics system 9100 then transmits 9414 the generated 9412 controlprogram update to the population of surgical hubs 9000. In oneexemplification, the control program update is transmitted 9414 to theentire population of surgical hubs 9000. In another exemplification, thecontrol program update is transmitted 9414 to the subpopulation ofsurgical hubs 9000 that did not utilize the data analysis algorithm thatsatisfied the update conditions. In other words, if the analytics system9100 analyzes 9406 the perioperative data and determines 9408 that thesecond (bimodal) data analysis method satisfies the update conditions,then the generated 9412 control program update is transmitted 9414 tothe first subpopulation of surgical hubs 9000 in this exemplification.Furthermore, the control program update can either force the updatedsurgical hubs 9000 to utilize the second (bimodal) data analysisalgorithm when analyzing the particular dataset or cause the updatedsurgical hubs 9000 to provide a warning or recommend to the user thatthe second (bimodal) data analysis algorithm be used under the givenconditions (allowing the user to choose whether to follow therecommendation).

This technique improves the performance of the surgical hubs 9000 byupdating their control programs generated from data aggregated acrossthe entire network of surgical hubs 9000. In effect, each surgical hub9000 can be adjusted according to shared or learned knowledge across thesurgical hub 9000 network. This technique also allows the analyticssystem 9100 to determine when unexpected devices (e.g., modular devices9050) are utilized during the course of a surgical procedure byproviding the analytics system 9100 with knowledge of the devices beingutilized in each type of surgical procedure across the entire surgicalhub 9000 network.

Security and Authentication Trends and Reactive Measures

In a cloud-based medical system communicatively coupled to multiplecommunication and data gathering centers located in differentgeographical areas, security risks are ever present. The cloud-basedmedical system may aggregate data from the multiple communication anddata gathering centers, where the data collected by any data gatheringcenter may originate from one or more medical devices communicativelycoupled to the data gathering center. It may be possible to connect anunauthorized medical device to the data gathering center, such as apirated device, a knock-off or counterfeit device, or a stolen device.These devices may contain viruses, may possess faulty calibration, lackthe latest updated settings, or otherwise fail to pass safetyinspections that can be harmful to a patient if used during surgery.Furthermore, the multiple data gathering centers may contain multiplepoints of entry, such as multiple USB or other input ports, oropportunities to enter user passwords, that if improperly accessed couldrepresent security breaches that can reach the cloud-based medicalsystem, other data gathering centers, and connected medical devices. Therisk of devices being tampered with, or data being stolen ormanipulated, can lead to severe consequences, particularly because theentire system is purposed for improving medical care.

A security system that reaches all facets of the cloud-based medicalsystem may not be effective unless there is a centralized component thatis configured to be made aware of all communication and data gatheringcenters, and all devices connected therein. If the security systems weremerely localized to each data gathering center or at each point ofentry, information from one point of entry may not be properlydisseminated to other security points. Thus, if a breach occurs at onepoint, or if improper devices are used at one point, that informationmay not be properly disseminated to the other centers or devices.Therefore, a centralized security system, or at least a systemconfigured to communicate with all medical hubs that control accesspoints, would be preferable to be made aware of all of the differentissues that may occur and to communicate those issues to other ports asneeded.

In some aspects, the cloud-based medical system includes a security andauthentication system that is configured to monitor all communicationand data gathering centers, such as a medical hub or tower located in anoperating room, as well as any smart medical instruments communicativelycoupled to those centers. The cloud-based security and authenticationsystem, as part of the cloud-based medical system, may be configured todetect unauthorized or irregular access to any hub system or otherprotected data sets contained within the cloud. Because of thecentralized nature of the cloud-based security system—in the sense thatthe cloud system is configured to communicate with every hub in thesystem—if there is any identified irregularity found at one hub, thesecurity system is operable to improve security at all other hubs bycommunicating this information to the other hubs. For example, ifsurgical instruments with unauthorized serial numbers are used at a hubin one hospital, the cloud-based security system may learn of this atthe local hub located in that hospital, and then communicate thatinformation to all other hubs in the same hospital, as well as allhospitals in the surrounding region.

In some aspects, the cloud-based medical system may be configured tomonitor surgical devices and approve or deny access for each surgicaldevice for use with a surgical hub. Each surgical device may beregistered with a hub, by performing an authentication protocol exchangewith the hub. The cloud-based medical system may possess knowledge ofall surgical devices and a status indicating whether the surgical deviceis acceptable, such as whether the device has been pirated, lacks aproper serial number, was faulty, possesses a virus, as so on. Thecloud-based medical system may then be configured to prevent interactionwith the surgical device, even if the surgical device is connected tothe hub.

In this way, the cloud-based security system can provide the mostcomprehensive security for any particular hub or medical facility due toits ability to see problems located elsewhere.

FIG. 197 provides an illustration of example functionality by a cloudmedical analytics system 10000 for providing improved security andauthentication to multiple medical facilities that are interconnected,according to some aspects. Starting at block A reference 10002,suspicious activity may be registered from one facility or region as astarting point. The suspicious activity may come in various forms. Forexample, a surgical device may be recorded at a hub as having aduplicate serial number, or a number that is not known to be within anacceptable range, or that the serial number may already be registered ata different location. In some aspects, surgical devices may possessadditional authentication mechanisms, such as a type of electronic ordigital handshake exchange between the surgical device and the surgicalhub when they are connected. Each device may be programmed with adigital signature and/or knowledge of how to perform an authenticationprocess. The firmware of the surgical device may need to be properlyprogrammed to know how to perform during this exchange. Theauthentication handshake may periodically change, and may be specifiedby the cloud on a periodic basis. Any of these may fail duringinterconnection of the device with a medical hub, triggering an alertwith the medical hub and the cloud system 10000.

In some aspects, the cloud system 10000 may review the informationsupplied by the medical device that triggered the suspicious activity,and if the information is unequivocally fraudulent or faulty, an alertand a rejection of the device can occur, such that the medical devicewill be prevented from operating with the medical hub and/or othermedical hubs in the same facility. While the cloud system 10000 may beconfigured to prevent singularities, the cloud system 10000 may also becapable of utilizing its vast array of knowledge to develop additionalsecurity measures that a single hub as an entry port would be unable toperform on its own. An example is described further below.

At block B reference 10004, the activity at the local medical hub may betransmitted to the cloud for authentication by at least comparing thesurgical device to all known devices within the cloud network. In thisscenario, the surgical device may register as being suspicious or havingsome suspicious activity or property. The cloud may be configured tothen undergo a feedback loop of exchange with the local hub or facilityfrom which the suspicious device originated. The cloud may determine torequest additional data from that facility. In addition, the medicalfacility, via one or more surgical hubs, may request authentication orinterrogation data about one or more surgical devices from the cloud. Inthis example, a medical hub in a facility in Texas requests acommunication exchange with the cloud system 10000 for more data todetermine if the suspicious activity at one of its local hubs is trulyproblematic.

At block C reference 10006, the cloud authentication and security systemmay then be configured to perform additional data analysis to determinethe veracity of any threat and larger context of the nature of thissuspicious activity. In this example, the cloud-based security systemhas performed analysis and brings to light at least two pieces ofevidence of a security threat, which is expressed visually in the chartof block C. First, upon comparing the number of data requests andmedical interrogations across multiple medical facilities, it isdetermined that the current requesting facility in Texas has aninordinate number of data requests or medical interrogations compared toall other facilities. The cloud may be configured to flag this as onesecurity issue that needs to be addressed. Second, in comparison to thenumber of data requests, the number of suspicious data points orfindings is also inordinately high at the Texas facility. One or both ofthese realizations may prompt the cloud security system to enactdifferent security changes at the Texas facility in particular.

Thus, at block D reference 10008, in response to the identifiedanomalous behavior of the facilities in Texas as a whole, the cloudsecurity system may request additional data related to Texas to betterunderstand the nature of the practices and potential threats. Forexample, additional data regarding purchasing practices, vendors, thetype of surgical instruments being used, the type of surgical proceduresperformed in comparison to other facilities, and so forth, may beobtained from one or more surgical hubs at the Texas facility, or may beaccessed in data already stored in the cloud system 10000. The cloudsecurity system may be configured to look for additional anomalies andpatterns that may help determine how to change security proceduresspecific to the Texas facility, or the facilities in the Texas regiongenerally.

At block E reference 10010, once the additional information has beengathered and analyzed, the cloud security system may initiate a changedsecurity protocol for the Texas facility in particular that triggeredthis analysis from block A, as well as any new security procedures forany surgical devices that indicate a unique or above average threat. Forexample, it may be determined that a particular type of surgicaldevices, such as devices originating from a particular manufacturingfacility or having a particular set of unique identification numbers,may be faulty, pirated, or have some other kind of security risk. Thecloud system 10000 may have analyzed the suspicious data pointsoriginating from the Texas region, determined if there were anycommonalities or patterns, and issued a change in security protocolbased on these identified patterns. These devices may then be locked outfrom use at all surgical hubs, even if they are not connected to anysurgical hub at the present time. Other example changes regardingsecurity include modifying the types of data gathered to learn moreabout the types of threats or how widespread the threats are. Forexample, the suspicious activity in Texas may exhibit a certain patternor authentication signature of attempting to login in with the system,and so this pattern may be placed on an alert to other facilities inTexas and/or to other facilities to pay special attention to. In somecases, the pattern of suspicious activity may be correlated with anotherindicator, such as a brand or manufacturer, or a series of serialnumbers. The cloud system may send out alerts to those facilities knownto associate with these correlated indicators, such as all facilitiesthat utilize medical devices with the same manufacturer.

In addition, an augmented authentication procedure may be enacted at thelocalized Texas region. The cloud-security system may opt to performadditional authentication protocols for all devices originating out ofthe Texas facility, for example. These additional protocols may not bepresent or required at other facilities, since there is considered alower level of security risk based on the lack of suspicious activity.

In some aspects, as alluded to previously, the cloud-based securitysystem may also be configured to protect against unwanted intrusions,either to any hub or to the cloud system itself. This means that thesuspect medical device may be unable to access any data from any medicalhub, and may also be prevented from operating if it is connected to amedical hub. In a medical system utilizing the cloud system and multiplemedical hubs, the common protocol may require that only medical devicesconnected to a medical hub are authorized to operate on a patient, andtherefore the medical hub will have the capability of preventing adevice from activating. The limitation of any faulty or fraudulentsurgical device may be designed to protect a patient during a surgicalprocedure, and it can also be used to protect any surgical hub and thecloud itself. The same lockout procedure may be designed to stop bothscenarios from occurring.

In some aspects, the surgical hub may be configured to transmit data tothe cloud security system that better characterizes the nature of thesecurity flaws or intrusions. For example, the cloud security system maybe configured to store in memory the number of intrusion attempts, thesource of the intrusion attempt (e.g., from which surgical hub or evenwhat port or connection via the surgical hub), and what method forattempted intrusion there is, if any (e.g., virus attack, authenticationspoofing, etc.).

In some aspects, the cloud security system may also determine what typesof behaviors by a surgical device or other functions by a surgical hubare irregular, compared to a global average or just by each institution.The cloud security system may better identify what practices seemirregular in this way. The data logs of any surgical hub, or across anentire facility, may be recorded and securely stored in the cloudsystem. The cloud security system may then analyze the attempted accessrequests and actions to determine trends, similarities and differencesacross regions or institutions. The cloud security system may thenreport any irregularities to the institution and flag any identifiedirregularities for internal investigation into updates to protectagainst future breaches. Of note, a local hub or local facility withmultiple hubs may not realize if any of their authentication behaviorsare irregular, unless they are compared to a broader average orcomparison of other facilities. The cloud system may be configured toidentify these patterns, because it has access to authentication dataand procedures from these multiple facilities.

In some aspects, the cloud security system may be configured to analyzeany current hub control program versions and when it was updated. Thecloud security system may verify all updates are correct, and determinewhere their origins are. This may be an additional check to ensure thatthe software and firmware systems of the surgical devices are proper andhave not been tampered with.

In some aspects, the cloud security system may also determine largerthreats by analyzing multiple facilities at once. The system maydetermine, after aggregating data from multiple locations, any trends orpatterns of suspicious activity across a wider region. The securitysystem may then change security parameters across multiple facilitiesimmediately or in near real time. This may be useful to quickly react tosimultaneous attacks, and may make it even easier to solve simultaneousattacks by gathering data from the multiple attacks at once to betterincrease the chances and speed of finding a pattern to the attacks.Having the cloud system helps confirm whether attacks or suspiciousactivity occurs in isolation or is part of a grander scheme.

Data Handling and Prioritization

Aspects of the present disclosure are presented for a cloud computingsystem (computer-implemented interactive surgical system as describedabove) for providing data handling, sorting, and prioritization, whichmay be applied to critical data generated during various medicaloperations. The cloud computing system constitutes a cloud-basedanalytics system, communicatively coupled to a plurality of surgicalhubs 7006 and smart medical instruments such as surgical instruments7012. Typically, a healthcare facility, such as a hospital or medicalclinic, does not necessarily immediately recognize the criticality ofdata as it is generated. For example, if a medical instrument usedduring a perioperative period experiences a failure, the response ofmedical care facility personnel such as nurses and doctors may bedirected towards diagnosis of any medical complications, emergencymedical assistance, and patient safety generally. In this situation, thecriticality of the data might not be analyzed in a time sensitivemanner, or at all. Accordingly, the healthcare facility does notnecessarily timely respond to or even recognize critical data as suchdata is generated. Additionally, a particular healthcare facility canlack knowledge of the management of critical data from other similarlysituated facilities, either in its region, according to a similar size,and/or according to similar practices or patients, and the like. Thecloud-based analytics system may be specifically designed to addressthis issue of critical data and particularly the timing of data handlingthat is performed based on the criticality of data within the context ofhealthcare facility operations. The cloud-based analytics system mayquickly and efficiently identify critical data based on specificcriteria. In some situations, aggregate data is determined to becritical after the individual non-critical data comprising theaggregated data are aggregated. As used herein, handling critical data(which could be aggregated) may refer to data sorting, prioritizing, andother data handling based on specific criteria or thresholds.

To help facilitate timely and improved data sorting, handling, andprioritization, it would be desirable if a common source connected tomultiple healthcare facilities could sort, handle, and prioritizecritical data from these medical facilities in a holistic manner. Inthis way, insights could be generated by the common source based onusing this aggregated data from the multiple healthcare facilities. Invarious aspects, the cloud-based analytics system comprises the cloud7004 that is communicatively coupled to knowledge centers in a medicalfacility, such as one or more surgical hubs 7006, and is configured tosort, handle, and prioritize medical data from multiple healthcarefacilities. In particular, the cloud-based system can identify criticaldata and respond to such critical data based on the extent of theassociated criticality. For example, the cloud-based system couldprioritize a response as requiring urgent action based on the criticaldata indicating a serious perioperative surgical instrument 7012failure, such as one that requires intensive care unit (ICU)postoperative treatment. The data handling, sorting, and prioritizationdescribed herein may be performed by the processors 7008 of the centralservers 7013 of the cloud 7004 by, for example, executing one or moredata analytics modules 7034.

Critical data can be determined to be critical based on factors such asseverity, unexpectedness, suspiciousness, or security. Other criticalitycriteria can also be specifically selected such as by a healthcarefacility. Criticality can also be indicated by flagging a surgicalinstrument 7012, which in turn can be based on predetermined screeningcriteria, which could be the same or different as the factors describedabove. For example, a surgical instrument 7012 can be flagged based onits usage being correlated with severe post surgical operationcomplications. Flagging could also be used to trigger the prioritizeddata handling of the cloud-based analytics system. In connection with adetermination of criticality or flagging a surgical instrument 7012, thecloud 7004 can transmit a push message or request to one or moresurgical hubs 7006 for additional data associated with the use of thesurgical instrument 7012. The additional data could be used foraggregating data associated with the surgical instrument 7012. Forexample, after receiving the additional data, the cloud 7004 maydetermine there is a flaw in the surgical instrument 7012 (e.g.,malfunctioning generator in an energy surgical instrument) that iscommon to other corresponding surgical instruments 7012 in a particularhealthcare facility. Accordingly, the cloud 7004 could determine thatall such flawed surgical instruments 7012 should be recalled. Theseflawed surgical instruments 7012 might share a common identificationnumber or quality or a common aspect of a unique identifier, such as aserial number family identifier.

In general, the cloud-based analytics system may be capable ofaggregating, sorting, handling, and prioritizing data in a timely andsystematic manner that a single healthcare facility would not be able toaccomplish on its own. The cloud-based analytics system further canenable timely response to the aggregated, sorted, and prioritized databy obviating the need for multiple facilities to coordinate analysis ofthe particular medical data generated during medical operations at eachparticular facility. In this way, the cloud-based system can aggregatedata to determine critical data or flagging for enabling appropriateresponses across the entire network of surgical hubs 7006 andinstruments 7012. Specifically, appropriate responses include sorting,handling, and prioritization by the cloud 7004 according to a prioritystatus of the critical data, which can enable timely and consistentresponses to aggregated critical data (or critical aggregated data)across the entire network. Criticality of the data may be defineduniversally and consistently across all surgical hub 7006 andinstruments 7012. Furthermore, the cloud-based analytics system may beable to verify the authenticity of data from the plurality of medicalfacilities before such data is assigned a priority status or stored inthe aggregated medical data databases. As with the categorization ofcritical data, data verification can also be implemented in a universaland consistent manner across the system which a single facility may notbe able to achieve individually.

FIG. 198 is a flow diagram of the computer-implemented interactivesurgical system programmed to use screening criteria to determinecritical data and to push requests to a surgical hub to obtainadditional data, according to one aspect of the present disclosure. Inone aspect, once a surgical hub 7006 receives device data 11002 from asurgical instrument 7012 data may be flagged and/or determined to becritical based on predetermined screening criteria. As shown in FIG. 198, the hub 7006 applies 11004 the screening criteria to flag devices andto identify critical data. The screening criteria include severity,unexpectedness, suspiciousness, and security. Severity can refer to theseverity of any adverse medical consequences resulting from an operationperformed using the surgical instrument 7012. Severity could be assessedusing a severity threshold for surgical instrument 7012 failures. Forexample, the severity threshold could be a temporal or loss ratethreshold of bleeding such as over 1.0 milliliters per minute (mL/min).Other suitable severity thresholds could be used. Unexpectedness canrefer to a medical parameter of a deviation that exceeds a thresholdsuch as an amount of standard deviation from the mean medical parametervalue such as a determined tissue compression parameter significantlyexceeding the expected mean value at a time during an operation.

Suspiciousness can refer to data that appears to have been improperlymanipulated or tampered with. For example, the total therapeutic energyapplied to tissue value indicated by the data may be impossible given atotal amount energy applied via the generator of the surgical instrument7012. In this situation, the impossibility of the data suggests impropermanipulation or tampering. Similarly, security can refer to improperlysecured data, such as data including a force to close parameter that wasinadvertently deleted. The screening criteria also may be specified by aparticular surgical hub 7006 or by the cloud 7004. The screeningcriteria can also incorporate specific thresholds, which can be used forprioritization, for example. In one example, multiple severitythresholds can be implemented such that the extent of perioperativesurgical instrument 7012 failures can be sorted into multiple categoriesaccording to the multiple severity thresholds. In particular, themultiple severity thresholds could be based on the number of misalignedstaples from a stapling surgical instrument 7012 to reflect an extent ofthe severity of misalignment. By using the cloud-based analytic system,the cloud may systemically identify critical data and flag surgicalinstruments 7012 for providing a timely and appropriate response whichan individual healthcare facility could not achieve on its own. Thistimely response by the cloud 7004 can be especially advantageous forsevere post surgical operation complications.

Determining critical data and flagging the surgical instrument 7012 bythe hub 7006 may include determining a location to store data. Data maybe routed or stored based on whether the data is critical and whetherthe corresponding surgical instrument 7012 is flagged. For example,binary criteria can be used to sort data into two storage locations,namely, a memory of a surgical hub 7006 or the memory 7010 of the cloud7004. Surgical instruments 7012 generate this medical data and transmitsuch data, which is denoted as device data 11002 in FIG. 198 , to theircorresponding surgical hub devices 7006. FIG. 198 illustrates an exampleof this binary sorting process. Specifically, in one aspect, the datarouting can be determined based on severity screening criteria as shownat the severity decision steps 11006, 11008. At step 11006, the hub 7006determines 11006 whether the surgical instrument 7012 that provided thedevice data 11002 has experienced a failure or malfunction duringoperation at the perioperative stage and whether this failure isconsidered severe. The severity thresholds discussed above or othersuitable means could be used to determine whether the failure is severe.For example, severe failure may be determined based on whetherundesirable patient bleeding occurred during use or firing of thesurgical instrument. If the determination at step 11006 is yes, thecorresponding data (i.e., critical data) of the surgical instrument 7012is transmitted 11012 by the hub 7006 to the cloud 7004. Conversely, ifthe determination at step 11006 is no, the flow diagram may proceed tostep 11008.

If the determination at step 11006 is no, then the flow diagram proceedsto step 11008 in FIG. 198 , where the surgical hub 7006 determineswhether the patient transitioned to non-standard post-operation care(i.e. the ICU) after the operation was performed with the specificsurgical instrument 7012. However, even if the determination at step11006 is no, the inquiry at step 11008 may still be performed. If thedetermination at step 11008 is yes, then the critical device data 11002is transmitted to the cloud 7004. For example, the determination at step11008 is yes if a patient transitioned into the ICU from the operatingroom subsequent to a routine bariatric surgical procedure. Upon transferof a patient into the ICU, the surgical hub 7006 may receive a timelysignal from the surgical instrument 7012 used to perform the bariatricprocedure indicating that the patient has experienced complicationsnecessitating entry into the ICU. Since this signal indicates the step11008 determination is yes, corresponding device data 11002 is sent11012 to the cloud 7004. Additionally, the specific surgical instrument7012 may be flagged by the cloud 7004 for a prompt specific response bythe cloud 7004, such as designating the surgical instrument 7012 with aprioritization of requiring urgent action. If the determination at step11008 is no, a signal can be transmitted from the surgical instrument7012 to the surgical hub 7006 indicating that the procedure wassuccessful. In this scenario, the device data 11002 can be stored 11010locally in a memory device of the surgical hub 7006.

Additionally or alternatively, the specific surgical instrument 7012 mayalso be flagged by the hub 7006 or the cloud 7004 to trigger datahandling by the cloud 7004, which can comprise an internal response ofthe cloud 7004. When the surgical instrument 7012 is flagged or thedevice data 11002 is determined to be critical, the triggered responsemay be the cloud 7004 transmitting a signal comprising a request foradditional data regarding the surgical instrument 7012. Additional datamay pertain to the critical device data 11002. The cloud 7004 can alsorequest additional data even if the specific surgical instrument 7012 isnot flagged, such as if the device data 11002 is determined to becritical without the surgical instrument 7012 being flagged. Flaggingcould also indicate an alarm or alert associated with the surgicalinstrument 7012. In general, the hub 7006 is configured to executedetermination logic for determining whether the device data 11002 shouldbe sent to the cloud 7004. The determination logic can be consideredscreening criteria for determining criticality or flagging surgicalinstruments 7012. Besides the severity thresholds used at steps decisionsteps 11006, 11008, the data routing can be based on frequencythresholds (e.g., the use of a surgical instrument 7012 exceeds a usagequantity threshold such as a number of times an energy generator isused), data size thresholds, or other suitable thresholds such as theother screening criteria discussed above. Flagging may also result instoring a unique identifier of the specific surgical instrument in adatabase of the cloud-based system.

A triggered request 11014 for additional data by the cloud 7004 to thehub 7006 may be made based on a set of inquiries as shown in FIG. 198 .This triggered request 11014 may be a push request sent by the centralservers 7013 of the cloud 7004. In particular, the processors 7008 canexecute the data collection and aggregation data analytic module 7022 toimplement this trigger condition functionality. This push request maycomprise an update request sent by the cloud 7004 to the hub 7006 toindefinitely collect new data associated with the device data 11002.That is, the hub 7006 may collect additional data until the cloud 7004transmits another message rescinding the update request. The pushrequest could also be a conditional update request. Specifically, thepush request could comprise initiating a prompt for the hub 7006 to sendadditional information only if certain conditions or events occur. Forexample, one condition might be if the sealing temperature used by thesurgical instrument 7012 to treat tissue exceeds a predeterminedthreshold. The push request could also have a time bounding component.In other words, the push request could cause the surgical hub 7006 toobtain additional data for a specific predetermined time period, such asthree months. The time period could be based on an estimated remaininguseful life of the surgical instrument 7012, for example. As discussedabove, the request 11014 for additional data may occur after thespecific surgical instrument 7012 is flagged, which may be due to anaffirmative determination at steps 11006, 11008 described above.

As shown in FIG. 198 , the triggered request 11014 for additional datamay include four inquiries that can be considered trigger conditions foradditional information. At the first inquiry, the hub 7006 determines11016 whether the device data 11002 represents an outlier with no knowncause. For example, application of therapeutic energy to tissue during asurgical procedure by the surgical instrument 7012 may cause patientbleeding even though surgical parameters appear to be within a normalrange (e.g., temperature and pressure values are within expected range).In this situation, the critical device data 11002 indicates anirregularity without a known reason. The outlier determination 11016 canbe made based on comparison of the device data 11002 to an expectedvalue or based on a suitable statistical process control methodology.For example, an actual value of the device data 11002 may be determinedto be an outlier based on a comparison of the actual value to a meanexpected (i.e., average) value. Calculating that the comparison isbeyond a certain threshold can also indicate an outlier. For example, astatistical process control chart could be used to monitor and indicatethat the difference between the actual and expected value is a number ofstandard deviations beyond a threshold (e.g., 3 standard deviations). Ifthe device data 11002 is determined to be an outlier without a knownreason, the request 11014 is triggered by the cloud 7004 to the hub7006. In response, the hub 7006 timely transmits 11024 additionalinformation to the cloud 7004, which may provide different, supporting,or additional information to diagnose the reason for the outlier. Otherinsights into the outlier may also be derived in this way. For example,the cloud 7004 may receive additional surgical procedure parameterinformation such as the typical clamping force used by other surgicalinstruments 7012 at the same point in the surgical procedure when thepatient bleeding occurred. The expected value may be determined based onaggregated data stored in the aggregated medical data database 7012,such as by averaging the outcomes or performance of groups of similarlysituated surgical instruments 7012. If at step 11016, the data is notdetermined to be an outlier, the flow diagram proceeds to step 11018.

The second inquiry is another example of a trigger condition. At step11018, the hub 7006 determines 11018 whether device data 11002 involvesdata that can be classified as suspicious, which can be implemented bythe authorization and security module 7024. For example, suspicious datamay include situations in which an unauthorized manipulation isdetected. These include situations where the data appears significantlydifferent than expected so as to suggest unauthorized tampering, data orserial numbers appear to be modified, security of surgical instruments7012 or corresponding hub 7006 appears to be comprised. Significantlydifferent data can refer to, for example, an unexpected overall surgicaloutcome such as a successful surgical procedure occurring despite asurgical instrument 7012 time of usage being significantly lower thanexpected or a particular unexpected surgical parameter such as a powerlevel applied to the tissue significantly exceeding what would beexpected for the tissue (e.g., calculated based on a tissue impedanceproperty). Significant data discrepancies could indicate data or serialnumber modification. In one example, a stapling surgical instrument 7012may generate a separate unique staple pattern in a surgical operationwhich may be used to track or verify whether the serial number of thatstapling surgical instrument 7012 is subsequently modified. Furthermore,data or serial number modification such as tampering may be detected viaother associated information of a surgical instrument 7012 that can beindependently verified with the aggregated medical data databases 7011or some other suitable data modification detection technique.

Moreover, compromised security, such as unauthorized or irregular accessto any surgical hub 7006 or other protected data sets stored within thecloud 7004 can be detected by a cloud-based security and authenticationsystem incorporating the authorization and security module 7024. Thesecurity and authentication system can be a suitable cloud basedintrusion detection system (IDS) for detecting compromised security orintegrity. The cloud IDS system can analyze the traffic (i.e. networkpackets) of the cloud computing network 7001 or collect information(e.g., system logs or audit trails) at various surgical hub 7006 fordetecting security breaches. Compromised security detection techniquesinclude comparison of collected information against a predefined set ofrules corresponding to a known attack which is stored in the cloud 7004and anomaly based detection. The cloud 7004 can monitor data from aseries of surgical operations to determine whether outliers or datavariations significantly reduce without an apparent reason, such as areduction without a corresponding change in parameters of used surgicalinstruments 7012 or a change in surgical technique. Additionally,suspiciousness can be measured by a predetermined suspiciousness orunexpectedness threshold, unauthorized modification of device data11002, unsecure communication of data, or placement of the surgicalinstrument 7012 on a watch list (as described in further detail below).The suspiciousness or unexpectedness threshold can refer to a deviation(e.g., measured in standard deviations) that exceeds surgical instrument7012 design specifications. Unauthorized data communication ormodification can be determined by the authorization and security module7024 when the data encryption of the cloud 7004 is violated or bypassed.In sum, if the hub 7006 determines 11018 the data is suspicious for anyof the reasons described above, the request 11014 for additional datamay be triggered. In response, the hub 7006 timely transmits 11024additional information to the cloud 7004, which may provide different,supporting, or additional information to better characterize thesuspiciousness. If at step 11018, the answer to the second inquiry isno, the flow diagram proceeds to step 11020.

The third and fourth inquiries depict additional trigger conditions. Atstep 11020, the hub 7006 may determine that device data 11002 indicatesa unique identifier of the surgical instrument 7012 that matches anidentifier maintained on a watchlist (e.g., “black list” of prohibiteddevices). As described above, the “black list” is a watch list that canbe maintained as a set of database records comprising identifierscorresponding to prohibited surgical hubs 7006, surgical instruments7012, and other medical devices. The black list can be implemented bythe authorization and security module 7024. Moreover, surgicalinstruments 7012 on the black list may be prevented from fullyfunctioning or restricted from access with surgical hubs 7006. Forexample, an energy surgical instrument 7012 may be prevented fromfunctioning (i.e. an operational lockout) via the cloud 7004 or surgicalhub 7006 transmitting a signal to the hub 7006 or surgical instrument7012 to prevent the generator from applying power to the energy surgicalinstrument 7012. This operational lockout can generally be implementedin response to an irregularity indicated by the critical device data11002. Surgical instruments can be included on the black list for avariety of reasons such as the authorization and security module 7012determining the presence of counterfeit surgical instruments 7012 usinginternal authentication codes, unauthorized reselling of surgicalinstruments 7012 or related products from one region to another,deviation in performance of surgical instruments 7012 that isnonetheless within design specifications, and reuse of surgicalinstruments 7012 or related products that are designed for singlepatient use. For example, internal authentication codes may be uniqueidentifiers maintained by the cloud 7004 in the memory devices 7010.Other unauthorized usage could also result in placement on the blacklist.

The use of counterfeit authentication codes may be a security breachthat is detectable by the cloud IDS system. Reselling of surgicalinstruments 7012 into other regions could be detected via regionspecific indicators of resold surgical instrument 7012 or surgical hubs7006, for example. The region specific indicator could be encryptedusing a suitable encryption technique. In this way, the cloud 7004 maydetect when the region specific indicators of a resold surgicalinstrument 7012 do not match the corresponding region of intended use.Reuse of a single use surgical instrument 7012 can be monitored bydetecting tampering with a lockout mechanism (e.g., a stapler cartridgelockout mechanism of a stapling surgical instrument), programming amicroprocessor of the single use surgical instrument 7012 to transmit awarning signal to the corresponding surgical hub 7006 when more than oneuse occurs, or another suitable detection technique. Performancedeviation could be monitored using statistical process control methodsas described above. The design specifications of particular surgicalinstruments 7012 may be considered the control limits of a statisticalprocess control methodology. In one example, when detected by the cloud7004, a significant trend toward one of the lower or upper controllimits constitutes a sufficient deviation that results in the cloud 7004adding the corresponding surgical instrument to the black list. Asdiscussed above, a deviation that exceeds design specifications mayresult determining 11018 the device data 11002 is suspicious. Surgicalinstruments 7012 may be added to or removed from the black list by thecloud 7004 based on analysis of the requested additional data. In sum,if the hub 7006 determines 11020 the surgical instrument 7012corresponding to the device data 11002 is on the watchlist, the request11014 for additional data may be triggered. In response, the hub 7006timely transmits 11024 additional information to the cloud 7004, whichmay provide different, supporting, or additional information. If at step11020, the answer to the second inquiry is no, the flow diagram proceedsto step 11022.

The trigger condition at step 11022 comprises the hub 70006 determiningwhether the device data 11002 indicates the surgical instrument 7012 hasmalfunctioned. In one aspect, a surgical instrument 7012 malfunctionresults in an automated product inquiry through the correspondingsurgical hub 7006. The hub 7006 sending 11024 additional data to thecloud 7004 may comprise all pertinent data of the surgical instrument7012 being immediately transmitted to the cloud through the surgical hub7006, which may result in central server 7013 processors 7008 of thecloud 7004 executing an automated product inquiry algorithm. However,such an algorithm may not be immediately executed or at all if themalfunction is not significant. The cloud 7004 may be configured torecord this set of pertinent data for all surgical instruments 7012 forcontingent use when such automated product inquiries are instituted. Theautomated product inquiry algorithm comprises the cloud 7004 searchingfor previous incidents that are related to the malfunction. The cloud7004 may populate a group of records in the aggregated medical datadatabases 7011 with any incidents or activity related to themalfunction. Subsequently, a corrective and preventive action (CAPA)portion of the algorithm may be instituted for reducing or eliminatingsuch malfunctions or non-conformities. CAPA and the automated productinquiry algorithm are one example of a possible internal response 11102of the cloud 7004 of the cloud-based analytics system.

CAPA involves investigating, recording and analyzing the cause of amalfunction or non-conformity. To implement CAPA, the cloud 7004 mayanalyze the populated related records in the aggregated medical datadatabases 7011, which may include aggregated data fields such assurgical instrument 7012 manufacture dates, times of use, initialparameters, final state/parameters, and surgical instrument 7012 numbersof uses. Thus, both individual and aggregated data maybe used. In otherwords, the cloud 7004 may analyze both individual data corresponding tothe malfunctioning surgical instrument 7012 as well as aggregated data,collected from all related surgical instruments 7012 to themalfunctioning surgical instrument 7012, for example. Initial and finalparameters may be, for example, an initial and final frequency of anapplied RF signal of the surgical instrument. CAPA can also involveanalysis of the previous time period from when the malfunction occurredor was detected. Such a time period can be, for example, one to twominutes. Based on this CAPA analysis, the cloud 7004 may diagnose theroot cause of the malfunction and recommend or execute any suitablecorrective action (e.g., readjusting miscalibrated parameters). Theautomated product inquiry algorithm can also involve a longer follow upof patient outcomes for patients treated with the specific surgicalinstrument 7012.

For example, the cloud 7004 may determine a priority status of watchlist for the surgical instrument 7012 so that the surgical instrument7012 may be monitored for a period of time after the malfunction isdetected and addressed. Moreover, the malfunction may cause the cloud7004 to expand a list of medical items to be tracked (e.g., theintegrity of tissue seals made during surgery). This list of items to betracked may be performed in conjunction with the patient outcomemonitoring by the patient outcome analysis module 7028. The cloud 7004may also respond to an irregularity indicated by the malfunction bymonitoring patient outcomes corresponding to the irregularity. Forexample, the cloud 7004 can monitor whether the irregularity correspondsto unsuccessful surgical operations for a predetermined amount of timesuch as 30 days. Any corrective action also can be assessed by the cloud7004. Other data fields can also be monitored in addition to the fieldsdiscussed above. In this way, the cloud may timely diagnose and respondto surgical instrument 7012 malfunctions using individual and aggregatedata in a manner that an individual healthcare facility could notachieve.

In one aspect, if the answer to any of steps 11016, 11018, 11020, 11022(i.e. trigger conditions) is affirmative (i.e. the trigger condition isactivated), then additional data associated or pertinent to the devicedata 11002 is sent to the cloud 7004, as can be seen in FIG. 198 . Thisadditional data may be handled by the data sorting and prioritizationmodule 7032 while the patient outcome analysis module 7028 may analyzethe data, for example. In contrast, if the answer to all of steps 11016,11018, 11020, 11022 is negative, then the respective data is stored11026 within the corresponding surgical hub 7006. Thus, when the answerat step 11022 is no, the device data 11002 may be stored locally withinthe hub 7006 and no additional data is requested of the hub 7006.Alternatively, the device data may be sent to the cloud 7006 for storagewithin the memory devices 7010, for example, without any triggeredrequests 11014 by the cloud 7004 for additional data. Steps 11016,11018, 11020, 11022 could also be used for identifying critical data orflagging the surgical instrument (if the specific surgical device hasnot already been flagged based on steps 11006, 11008) as part of thescreening criteria applied at step 11004. Other trigger conditions asidefrom steps 11016, 11018, 11020, 11022 are also possible for triggeringthe request 11014 for additional data. The request can be sent to allsurgical hubs 7006 or a subset thereof. The subset can be geographicallyspecific such that, for example, if surgical hub 7006 used in healthcarefacilities located in Illinois and Iowa have malfunctioned in a similarmanner, only surgical hub 7006 corresponding to healthcare facilities inthe Midwestern United States are requested 11014 for additionalinformation. The requested additional data can be different orsupporting data concerning the particular use of surgical instruments7012 so that the cloud 7004 may gain additional insight into the sourceof the irregularity, as represented by steps 11016, 11018, 11020, 11022.For example, if malfunctioning surgical instruments 7012 are causingundesirable patient bleeding, the cloud 7004 may request timinginformation regarding this bleeding for help in potentially diagnosingwhy the malfunction is causing the bleeding.

The criticality of data can be identified based on the screeningcriteria as described above, or by any other suitable data analysistechnique. In one aspect, as shown in FIG. 199 , when the critical datais determined, an internal analytic response 11102 of the cloud 7004 maycommence. The internal analytic response 11102 can advantageously bemade in a timely manner such as in real time or near real time. Asdiscussed above, the criticality of data can be identified based on theseverity of an event, the unexpected nature of the data, thesuspiciousness of the data, or some other screening criteria (e.g., aninternal business flag). The determination of critical data can involvea request generated by a surgical hub 7006 based on the surgical hub7006 detecting an irregularity or failure of a corresponding surgicalinstrument 7012 or of a component of the surgical hub 7006 itself. Therequest by the surgical hub 7006 may comprise a request for a particularprioritization or special treatment of critical data by the cloud 7004.In various aspects, the cloud internal analytic response 11102 could beto escalate an alarm or response based on the frequency of the eventassociated with the critical device data 11002, route the device data11002 to different locations within the cloud computing system, orexclude the device data 11002 from the aggregated medical data databases7011. In addition, the cloud 7004 could also automatically alter aparameter of a malfunctioning surgical instrument 7012 so thatmodifications for addressing the malfunction can be implemented in realtime or near real time. In this manner, even malfunctions that are notreadily detected by a clinician in a healthcare facility, for example,may still be advantageously addressed in a timely manner by the cloud7004.

FIG. 199 is a flow diagram of an aspect of responding to critical databy the computer-implemented interactive surgical system, according toone aspect of the present disclosure. In particular, the internalanalytic response 11102 by the cloud 7004 can include handling criticaldata which includes determining a priority status to determine a timecomponent or prioritization of the response. The response 11102 itselfmay be based on an operational characteristic indicated by the criticaldata, such as the characteristics described above in connection with thescreening criteria or the trigger conditions of FIG. 198 . The internalresponse 11102 may be implemented by the data sorting and prioritizationmodule 7032 as well as the data collection and aggregation module 7022.As shown in FIG. 199 , in the prioritization branch of the flow diagram(labeled as Q1 in FIG. 199 ) the cloud may incorporate the binarydecision of whether to exclude the critical data from the aggregatedmedical data databases 7011 with a priority escalation decisionframework. At step 11104 of FIG. 199 , the cloud 7004 determines whetherthe critical data should be excluded from the aggregated medical datadatabases 7011. The exclusion determination may be considered athreshold determination.

It can be desirable to exclude critical data from the aggregated medicaldata databases 7011 for verification purposes. For example, criticaldata that is flagged or designated for special routing may be placed ona hold list maintained by the cloud 7004. The hold list is maintained ata separate storage location in the memory 7010 relative to theaggregated medical data databases 7011 within the cloud 7004, such asthe caches 7018. The excluded critical data could also be stored in amore permanent storage location in the memory 7010. Accordingly, if theanswer to step 11104 is yes, the cloud 7004 stores 11118 the criticaldata in the hold list. The cloud 7004 may then validate or verify thatthe critical device data 11002 is accurate. For example, the cloud 7004may analyze whether the device data 11002 is logical in light of acorresponding patient outcome or analyze additional associated data ofthe device data 11002. Upon proper verification, the device data 11002may also be stored within the aggregated medical data databases 7011.But if the device data 11002 is not verified, the cloud 7004 may notinclude the unverified device data 11002 in the priority escalationdecision framework. That is, before verification, the device data 11002may not be assigned a priority status according to the priority statusclassification 11106 for the internal cloud response 11102.

However, if the device data 11002 is verified, the flow diagram mayproceed to the priority status classification 11106. Accordingly, if theanswer to the exclusion determination at step 11104 is no, the devicedata 11002 is prioritized according to the priority escalation decisionframework, which can define a predetermined escalation method forhandling critical data. As shown in FIG. 199 , a predeterminedescalation prioritization system 11106 (i.e., priority escalationdecision framework) can comprise four categories, including watch list,automated response, notification, and urgent action required. Thispredetermined escalation prioritization system 11106 can be considered aform of triage based on classifying critical data according a prioritystatus and escalating between statuses based on particular thresholds.For example, priority can be escalated based on a frequency of eventthreshold such as the number of misaligned staples fired by a staplingsurgical instrument 7012 over a predetermined number of surgicaloperations. Multiple staggered frequency or other thresholds could alsobe used. The lowest priority level of the priority status classification11106 is the watch list level designated at level A. As discussed above,the watch list may be a black list maintained in the memory 7010 as aset of database records of identifiers corresponding to prohibitedsurgical hubs 7006. Surgical hubs 7006 can be prohibited to differentextents depending on the nature of the critical device data 11002 oradditional data. For example, surgical hubs 7006 may be partially lockedout such that only the device components experiencing problems areprevent from functioning. Alternatively, surgical hub 7006 on the watchlist may not be restricted from functioning in any way. Instead, thesurgical hubs 7006 may be monitored by the cloud 7004 for any additionalirregularities that occur. Accordingly, the watch list is designated atlevel A, the least urgent priority status. As shown in the prioritystatus classification 11106, the automated response at level B is thenext most urgent priority status. An automated response could be, forexample, an automated initial analysis of the device data 11002 by thepatient outcome analysis module 7028 of the cloud 7004 via a set ofpredefined diagnostic tests.

The third most urgent priority status is notification, which isdesignated at level C of the priority status classification 11106. Inthis situation, the cloud 7004 transmits a wireless signal to ahealthcare facility employee, clinician, healthcare facility department,or other responsible party depending on the nature of the device data11002. The notification signal can be received at a receiver devicelocated at a suitable location within the healthcare facility, forexample. Receiving the notification signal can be indicated by avibration or sound to notify the responsible party at the healthcarefacility. The holder of the receiver device (e.g., a healthcare facilityclinician) may then conduct further analysis of the critical device data11002 or additional data or other analysis for resolving an indicatedirregularity. If a solution to the irregularity is known, the solutionmay be timely implemented. The most urgent priority status as depictedin the priority status classification 11106 is urgent action required,which is designed at level D. Urgent action required indicates that aresponsible party, device or instrument should immediately analyze anddiagnose the problem implicated by the critical data. Upon properdiagnosis, an appropriate response should immediately be performed. Inthis way, the cloud 7004 may implement a comprehensive approach tocritical data prioritization and triaging that no individual medicalfacility could achieve on its own. Critical data may be handled in atimely manner according to suitable priority levels which can addresssolving time sensitive problems that arise in the healthcare field.Moreover, the cloud 7004 can prioritize aggregated critical data fromall healthcare facilities categorized within a particular region.Accordingly, the time sensitive prioritized approach to handlingcritical data can be applied system wide, such as to a group ofhealthcare facilities. Furthermore, the cloud 7004 can generate an alertfor a responsible party to respond to critical data (and associatedissues implicated by such critical data) in a timely way such as in realtime or in near real time according to a corresponding priority status.This alert can be received by a suitable receiver of the responsibleparty. The priority status of the device data 11002 could also bedetermined based on the severity of the surgical issue implicated by thedevice data 11002. As discussed above, the cloud 7004 may receiveadditional data from surgical hubs 7006 or surgical instruments 7012(via the hubs 7006) which causes the cloud 7004 to elevate the prioritystatus of the device data 11002.

In one aspect, based on a priority status, the device data 11002 may besubject to the flagging screening at a specific time depending onpriority. For example, the device data 11002 may be indicated ascritical data but not yet flagged. Additionally, the device data 11002may first receive an automated response level of priority according tothe priority status classification 11106. In this situation, theseverity determination at step 11108 may be relatively quickly inaccordance with the level B of priority. Specifically, step 11108 may bereached without first placing the surgical instrument 7012 on a watchlist. The severity threshold used at step 11108 can be the same ordifferent from the severity threshold used in 11006. Aside from theseverity determination at step 11108, other determinations pertinent tothe irregularity indicated by the critical device data 11002 oradditional data may be made. These determinations may be used todiagnose the occurrence of a critical event. Accordingly, if the answerat step 11108 is yes, the frequency of the event may be assessed at step11110. Conversely, if the answer at step 11108 is no, the device data11002 or additional data can be stored 11118 in the hold list.Additionally or alternatively, the device data 11002 or additional datacan be routed to different storage locations within the cloud 7004according to the routing branch of the flow diagram (labeled as Q2 inFIG. 199 ). The cloud 7004 may wait for a request from the hub 7006 foralternative routing 11120 of the device data 11002 or additional data.At step 11110, the cloud 7004 determines the frequency that the criticalevent is occurring. Based on this frequency, the priority statusassigned according to the priority status classification 11106 can beescalated (see step 11116). For example, the critical event may be thegenerator of the surgical instrument 7012 is applying an insufficientsealing temperature to therapeutically treat tissue. In other words, theinquiry of step 11110 inquires whether the medical event implicated bythe critical data is occurring at an increasing frequency after theproblem was initially identified.

An increase in the number of times this insufficient sealing temperatureoccurs can be monitored to escalate priority status at step 11116, basedon frequency thresholds (see step 11112), for example. If at step 11110,the event is not increasing in frequency, the data can be stored 11118in the hold list. If the answer at step 11110 is yes (i.e., the event isincreasing in frequency), the flow diagram proceeds to step 11112. Atstep 11112, another data verification inquiry is made. In particular,specific thresholds such as the frequency thresholds described above maybe applied to determine whether the combination of device data 11002 oradditional data is sufficiently correct to ensure that the critical datashould be added to the aggregated medical data databases 7011.Furthermore, the data verification inquiry at step 11112 may comprise adecision regarding whether the sample size of the critical data issufficiently large (i.e., reached critical mass). Additionally oralternatively, the sample size is analyzed for whether there issufficient information to determine an appropriate internal response11102 of the cloud 7004. The data verification inquiry can also compriseverifying the accuracy of the data by comparison to predeterminedstandards or verification tests. If the answer to the inquiry at step11112 is negative, then the critical data is stored within the separatestorage location (e.g., hold list) in the cloud 7004. If the answer tothe inquiry at step 11110 is affirmative, the device data 11002 oradditional data is added to the aggregated medical data databases 7011.At step 11116, the priority status of the device data 11002 oradditional data is increased according to the priority statusclassification 11106. However, besides the event frequencydetermination, the addition to the aggregated medical data databases7011 may itself be an action that results in an elevation of thepriority status of the critical data at step 7. In any case, thepriority status of the device data 11002 or additional data may beescalated or deescalated as appropriate based on additional analysis ordata, for example. An internal response 11102 of the cloud 7004 may bemade according to the current priority status (i.e., one of levels A-D)of the critical data.

In addition to prioritizing critical data, the internal response 11102of the cloud 7004 can also involve advantageously routing, grouping, orsorting critical data the aggregated critical data in a timely manner.In particular, the data may be routed to different storage locationswithin the cloud 7004, such as in the memory devices 7010. This routingis illustrated by routing branch of the flow diagram labeled as Q2 inFIG. 199 at step 11120. As such, the memory devices 7010 of the centralservers 7013 of the cloud 7004 can be organized into various locationsthat correspond to a characteristic of the critical data or a responsecorresponding to the critical data. For example, the total memorycapability of the memory devices 7010 may be divided into portions thatonly store data according to individual data routing categories, such asthose used at steps 11122, 11124, 11126. As shown at step 11120 of FIG.199 , the critical data may be routed to different various cloud storagelocations. Step 11120 can occur in conjunction with or separately fromthe prioritization branch of the flow diagram. Step 11120 may betriggered by a request generated by a hub 7006. The hub 7006 maytransmit such a request because of detecting a failure or irregularityassociated with a surgical instrument 7012, for example. The associatedcritical data may then receive alternative routing 11120 by the cloud7004 to different cloud storage locations. At step 11122, thealternative routing 11120 can comprise geographical location basedrouting. That is, the different cloud storage locations may correspondto location based categorization of the cloud memory devices 7010.Various subsets of the cloud memory devices 7010 can correspond tovarious geographical regions. For example, surgical instruments producedfrom a manufacturing plant in Texas could be grouped together in storagewithin the cloud memory devices 7010. In another example, surgicalinstruments produced from a specific manufacturing company can becategorized together in the cloud memory devices 7010. Therefore,location based categorization can comprise the cloud 7004 routingcritical data based on associations with different manufacturing sitesor operating companies.

At step 11124, the alternative routing 11120 can comprise routing fordevice data 11002 or additional data that requires a rapid internalresponse 11102 of the cloud 7004. This alternative routing 11120 at step11124 could be integrated with the priority status classification 11106.For example, escalated or urgent priority critical data, such as thoseat priority level C and D, may be routed by the cloud 7004 to rapidresponse portions of the memory devices 7010 to enable a rapid response.For example, such critical data may be routed to rapid response caches7018 which signifies that a rapid response is necessary. At step 11126,device data 11002 or additional data that implicates a failure of a typethat requires special processing are routed to a special processingportion of the memory devices 7010. For example, a surgical instrument7012 may be determined to have experienced a failure or malfunctionduring operation based on a control program deficiency common to a wholegroup of surgical instruments 7012. In this situation, specialprocessing may be required to transmit a collective control programupdate to the group of surgical instruments 7012. Accordingly, the cloudmay route the critical data to the special processing portion of thememory devices 7010 to trigger this special processing. Subsequently,the special processing could also include the patient outcome analysisdata analytics module 7028 analyzing and monitoring the effect of thecontrol program update on patient outcomes. The patient outcome analysismodule 7028 may also execute an automated product inquiry algorithm asdiscussed above if necessary.

FIG. 200 is a flow diagram of an aspect of data sorting andprioritization by the computer-implemented interactive surgical system,according to one aspect of the present disclosure. This sorting andprioritization may be implemented by the data sorting and prioritizationmodule 7032, the data collection and aggregation module 7022, andpatient outcome analysis module 7028. As discussed above, criticaldevice data 11002 or additional data can implicate or correspond tovarious medical events, such as events 1 through 3 as depicted in FIG.200 . An event may be for example, a shift from a phase of tissuetreatment to another phase such as a shift from a phase corresponding tocutting with the specific surgical instrument to a phase correspondingto coagulation. In FIG. 200 , critical data associated with a firstmedical event 11202 is detected by the surgical hub 7006 and transmittedto the cloud 7004. Upon receiving the critical data, the cloud 7004analyzes the critical data at step 11208 to determine that it iscomparable to an expected value of the critical data, as described abovefor example at step 11016. When the critical data is determined ascomparable (i.e., the value of the critical data is expected), thecritical data may be aggregated within a large data set in theaggregated medical data databases 7011, for example. That is, at step11216, the critical data is stored within the aggregated databases ofthe cloud. As shown in FIG. 200 , the critical data is also subject to abinary classification at steps 11218, 11220. For example, the criticaldata can be distinguished by good properties and bad properties. Thedata sorting and prioritization modules can classify the critical dataas associated with a bleeding or a non-bleeding event, for example. Inthis way, the patient outcome analysis module 7028 may classify criticaldata as corresponding to a positive patient outcome at step 11218 or anegative patient outcome at step 11210.

FIG. 200 also shows the critical data associated with a second medicalevent 11204 is detected by the surgical hub 7006 and transmitted to thecloud 7004. The critical data associated with the second medical event11204 is determined by the cloud to be suspicious or unusual data atstep 11210, which is a trigger condition as described above withreference to step 11118. Accordingly, the cloud 7004 is triggered torequest 11114 additional data from the surgical hub 7006 at step 11212by transmitting a push message to the surgical hub 7006. As discussedabove, the additional data may enable the patient outcome analysismodule 7028 of the cloud 7004 to gain additional insight into the sourceof the irregularity implicated by the critical data. If the patientoutcome analysis module 7028 sufficiently diagnoses the cause of thesecond medical event 11214, the critical data or associated additionaldata is aggregated into the aggregated medical data databases 7011 atstep 11216 (see also step 11114). Subsequently, the critical data oradditional data is classified according to the good/bad binaryclassification at steps 11218, 11220. If the cloud 7004 cannotsufficiently diagnose the cause of the second medical event 11204, theprocess may proceed to step 11224, in which the critical data isevaluated by a suitable person or department of the correspondingmedical facility. Step 11224 can include the threshold data exclusiondetermination at step 11104. That is, because a good reason cannot bereadily determined for the suspicious or unusual data, the data may bestored in a hold list in accordance with step 11118. Additionally, thedevice data 11002 or additional data may be designated at prioritystatus level C, which triggers the evaluation at step 11224 (i.e.,healthcare facility employee, clinician, healthcare facility department,or other responsible party evaluates the data).

As illustrated in FIG. 200 , the critical data associated with a thirdmedical event 11206 is detected by the surgical hub 7006 and transmittedto the cloud 7004. The critical data associated with the third medicalevent 11206 is determined by the cloud 7004 to indicate that thecorresponding surgical instrument 7012 is experiencing a failure ormalfunction at step 11220. As discussed above, severity thresholds canbe used to determine whether the failure is severe. The failure ormalfunction may refer back to the trigger condition at step 11022 inFIG. 198 such that the surgical instrument malfunction results in anautomated product inquiry through the surgical hub 7006. As discussedabove, the automated product inquiry algorithm may comprise the patientoutcome analysis module 7028 searching for data of related incidentsstored within the cloud 7004 (e.g., the memory devices 7010). The dataof related incidents can include video, manufacturer, temporal, andother suitable types of data. Depending on the results of the automatedproduct inquiry, the third medical event 11206 critical data can beprioritized according to priority status classification 11106. Thus, forexample, the inquiry may result in a suspicious or unusual resultwithout a sufficient reason, so the critical data is designated atpriority level C. In this connection, a suitable person or department ofthe corresponding medical facility evaluates the critical data and theresults of the automated product inquiry at step 11224. The results ofthe evaluation could be, for example, that the results constitute anerror to be disregarded at step 11226 or that the results requireadditional special processing via the patient outcome analysis module7028 at step 11228 (see also step 11126). Such special processing atstep 11228 can be the CAPA portion of the automated product inquiryalgorithm, as described above. Thus, the cloud-based analytics systemmay generate timely alerts for triggering a response by the suitableperson or department in real time or near real time.

In general, the cloud-based analytics system described herein maydetermine critical data and perform timely data handling, sorting, andprioritizing based on priority status and specific thresholds asdescribed above. Accordingly, the cloud-based analytics systemadvantageously handles critical data in a timely, systematic, andholistic manner over multiple health care facilities. The critical datahandling comprises internal responses by the cloud 7004 based onassigned priority levels. Moreover, based on requests by surgical hubs7006, special routing of data within the memory device 7010 of the cloud7004 may be achieved. The rerouting, prioritizing, confirming, orrequesting supporting as described above may be used to improve analysisof the data by the cloud 7004.

Cloud Interface for Client Care Institutions

All client care institutions require some level of control in atreatment environment. For example, an institution may wish to controlinventory that is present within an operating room. Inventory itemswithin an operating room may include not only medical devices to be usedduring surgery (e.g., scalpels, clamps, surgical tools, etc.) but alsomedical supplies to be used during surgery in conjunction with suchmedical devices (e.g., gauze, sutures, staples, etc.). Heretofore,inventory control for many institutions comprises a simple manual countof inventory items on a periodic basis (e.g., daily, weekly, monthly,etc.). Similarly, other institutions utilize a barcode scanner to countand/or document inventory items on a periodic basis.

Aspects of the present disclosure are presented for a cloud interfaceaccessible by participating client care institutions via a cloud-basedanalytics system. In order to monitor and/or control inventory items tobe utilized or being utilized by an institution, each institution adoptsits own practice of documenting inventory item usage. For example, aninstitution may manually count and/or scan inventory items on a periodicbasis. Additional example details are disclosed in U.S. PatentApplication Publication No. 2016/0249917, entitled SURGICAL APPARATUSCONFIGURED TO TRACK AN END-OF-LIFE PARAMETER, which published on Sep. 1,2016, U.S. Patent Application Publication No. 2014/0110453, entitledSURGICAL INSTRUMENT WITH RAPID POST EVENT DETECTION, which issued onFeb. 23, 2016 as U.S. Pat. No. 9,265,585, U.S. Patent ApplicationPublication No. 2016/0310134, entitled HANDHELD ELECTROMECHANICALSURGICAL SYSTEM, which published on Oct. 27, 2017, and U.S. PatentApplication Publication No. 2015/0317899, entitled SYSTEM AND METHOD FORUSING RFID TAGS TO DETERMINE STERILIZATION OF DEVICES, which publishedon Nov. 5, 2015, the entire disclosures of which are hereby incorporatedby reference herein. Information regarding counted and/or scannedinventory items may then be stored in a local computer system to trackinventory item usage. Such a manual process is not only labor intensiveand inefficient, but also prone to human error. As a result, aninstitution may be unable to perform a surgical procedure(s) and/or thesurgical procedure(s) may be unnecessarily delayed because one or moreinventory items, required for the surgical procedure(s), are notavailable for use for various reasons (e.g., out of stock, in stock butexpired, in stock but no longer considered sterile, in stock butdefective, etc.). Knowing this, some institutions are forced to carryand/or hold an overstock of inventory items. This, of course, may resultin increase expense (e.g., more inventories) and ultimately unnecessarywaste (e.g., expired inventory items).

To help institutions control inventory items, it would be desirable forinstitutions to have access, via a cloud interface, to a cloud-basedanalytics system configured to automate inventory control byautomatically receiving data associated with inventory items of theinstitutions, deriving information based on the received data, andconveying, via the cloud interface, real-time knowledge back to theinstitutions regarding inventory items. Referring to FIG. 201 ,according to one aspect of the present disclosure, a client careinstitution system 8000 may transmit (e.g., periodically, in real-time,in batches, etc.) inventory data to a cloud-based analytics system 8002and the cloud-based analytics system 8002 may derive/extract informationfrom that inventory data. In such an aspect, a cloud-interface 8004 maybe accessed/queried by the client care institution system 8000 and thecloud-based analytics system 8002 may transmit its derived/extractedinformation to the cloud-interface 8004. Further, in such an aspect, thecloud-interface 8004 may convey/package/structure the derived/extractedinformation to the client care institution system 8000 to revealknowledge about the client care institution's inventory. In one aspect,the client care institution system may comprise a surgical system 102(e.g., FIG. 1 ), the cloud-based analytics system may comprise thecloud-based system 105 (e.g., FIG. 1 ) and the cloud-interface maycomprise at least one of a visualization system 108/208 (e.g., FIGS. 1-2) or a display 135/177 associated with the surgical hub 106 (e.g., FIGS.1-3, 7 , etc.).

Referring to FIG. 1 , in some aspects of the present disclosure, acloud-based system 105 is communicatively coupled to one or more thanone surgical hub of an institution (e.g., one or more than one surgicalhub 106 of a surgical system 102). Here, each surgical hub is incommunication (e.g., wirelessly) with one or more than one inventoryitem (e.g., intelligent instrument 112). The cloud-based system 105 maybe configured to aggregate data associated with each inventory item ofeach institution, analyze that data with respect to system-definedconstraints, and generate or facilitate a cloud interface for eachinstitution to monitor and control inventory items. In one example, thecloud-based system 105 may be configured to compute a currentavailability of each inventory item (e.g., an indication of real-timeusage and/or scheduled usage for each inventory item in a surgicalsystem 102), a current usage associated with each inventory item (e.g.,based on data received from one or more than one surgical hub 106 thathas read usage data from a chip/memory associated with each inventoryitem), irregularities, if any, associated with each inventory item(e.g., defects, etc.), current possible medical device combinations thatutilize each inventory item (e.g., various shafts, staple cartridges,end effectors, etc. combinable to form numerous medical devicecombinations), and available alternatives to each inventory item (e.g.,available shaft B and/or shaft C may be substituted for unavailableshaft A for a desired/input surgical procedure(s)). Referring to FIGS.202-203 , in such an exemplification, after input of a desired surgicalprocedure(s) (e.g., “cholecystectomy”) by an institution in its cloudinterface 8104, the cloud-based system 105 may provide up-to-date,real-time and/or near real-time knowledge regarding the availabilityand/or usability of inventory items (e.g., associated with and/or neededto perform the input surgical procedure(s)) based on the system-definedconstraints. Referring to FIG. 203 , in one example, the institution'scloud interface 8104 may display an inventory item 8106 (e.g., HandlesA, B, and C) in association with its current 8108 and/or remaining usage8110. If the remaining usage is not adequate (e.g., based on anticipatedusage necessary for the desired surgical procedure, etc.), the cloudinterface may further display a warning or alert regarding theinadequacy (e.g., 8112, highlighting, blacked out, etc.). Such a warningor alert may indicate that the surgical procedure(s) input at the cloudinterface cannot be performed based on current inventory items. In oneaspect, a same or similar warning or alert may be communicated to theinventory item itself for display on a user interface of the inventoryitem itself (e.g., a user interface of Handle C). In another aspect, thecloud interface may further display available alternatives to theinventory item (e.g., Handle B). Here, anticipated usage and/oravailable alternatives may be determined at the surgical hub 106 (e.g.,based on local data) and/or the cloud-based analytics system 105 (e.g.,based on local data of the surgical hub 106 and/or global data frommultiple surgical hubs 106 of multiple institutions). In one example,the surgical hub 106 may infer anticipated usage and/or availablealternatives from local data associated with the same or similarsurgical procedure (e.g., average number of uses to perform the same orsimilar surgical procedure, alternative inventory items used to performthe same or similar surgical procedure, etc.). In another example, thecloud-based analytics system 105 may similarly infer anticipated usageand/or available alternatives from local data of the surgical hub 106and/or global data from multiple surgical hubs 106 of multipleinstitutions (e.g., average number of uses to perform the same orsimilar surgical procedure, alternative inventory items used to performthe same or similar surgical procedure, etc.).

In other aspects of the present disclosure, a cloud-based system 105 iscommunicatively coupled to one or more than one surgical hub 106 of aninstitution, each surgical hub 106 in communication (e.g., wirelessly)with one or more than one inventory item (e.g., intelligent instrument112). The cloud-based system 105 may be configured to create a list ofinventory items not authorized to perform surgical procedures due to oneor more system-defined constraints. In one exemplification, after inputof a desired surgical procedure(s) by an institution into its cloudinterface (e.g., FIG. 202 ), the cloud-based system 105 may determinethat one or more inventory items of the institution (e.g., detected byand associated with and/or needed to perform the input surgicalprocedure(s)) are not authorized to perform the input surgicalprocedure(s) based on system-defined constraints. In such anexemplification, it may be determined that an identifier (e.g., serialnumber, unique ID, etc.) associated with an inventory item is notauthorized to perform the input surgical procedure(s) (e.g., inventoryitem exceeds usable life, inventory item is counterfeit, inventory itemis defective, etc.). In one example, the institution's cloud interfacemay display an inventory item in association with its unauthorizedstatus 8114. In such an aspect, the cloud interface may further displaya warning or alert regarding the unauthorized status (e.g.,highlighting, blacked out, etc.). Such a warning or alert may indicatethat the surgical procedure(s) input at the cloud interface cannot beperformed based on current inventory items. In one aspect, a same orsimilar warning or alert may be communicated to the inventory itemitself for display on a user interface of the inventory item itself(e.g., a user interface of Handle D). Similar to above, the cloudinterface 8104 may display available alternatives to the unauthorizedinventory item (e.g., Handle B).

In yet other aspects of the present disclosure, a cloud-based system 105is communicatively coupled to one or more than one surgical hub 106 ofan institution, each surgical hub 106 in communication (e.g.,wirelessly) with one or more than one inventory item (e.g., intelligentinstrument 112). The cloud-based system 105 may be configured to createa list of inventory items no longer authorized to perform surgicalprocedures due to one or more system-defined constraints. In oneexemplification, after input of a desired surgical procedure(s) by aninstitution in its cloud interface (e.g., FIG. 202 ), the cloud-basedsystem may determine that one or more inventory items are no longerauthorized to perform the input surgical procedure(s) based onsystem-defined constraints. In such an exemplification, it may bedetermined that an identifier (e.g., serial number, unique ID, etc.)associated with an inventory item is unusable (e.g., expired, no longersterile, defective, etc.). In one example, the institution's cloudinterface may display an inventory item in association with its unusablestatus 8116. In such an aspect, the cloud interface may further displaya warning or alert regarding the unusable status (e.g., highlighting,blacked out, etc.). Such a warning or alert may indicate that thesurgical procedure(s) input at the cloud interface cannot be performedbased on current inventory items. In one aspect, a same or similarwarning or alert may be communicated to the inventory item itself fordisplay on a user interface of the inventory item itself (e.g., a userinterface of Handle E). Similar to above, the cloud interface maydisplay available alternatives to the unusable inventory item (e.g.,Handle B).

In this way, the cloud-based system 105 of the present disclosure mayprovide up-to-date, real-time, and/or near real-time knowledge regardingthe availability of inventory items pertinent to the surgicalprocedure(s) input to the cloud interface of the participatinginstitutions. Such a system goes well-beyond conventional processes ofmanually counting and/or scanning inventory items.

FIG. 204 illustrates an example multi-component surgical tool (e.g., awireless surgical device/instrument 235) comprising a plurality ofmodular components 8204, 8206, 8208, 8210, wherein each modularcomponent is associated with an identifier 8214, 8216, 8218, 8220respectively (e.g., a serial number). In particular, the surgical tool235 of FIG. 204 includes a handle 8204, a modular adapter 8206, and endeffector 8208 (e.g., a disposable loading unit and/or a reloadabledisposable loading unit in various aspects), and a staple cartridge8210. In this example, the handle 8204 is associated with serial number“SN135b”, the modular adapter 8206 is associated with serial number“SN33b”, the end effector 8208 is associated with serial number “SN1a”and the staple cartridge 8210 is associated with serial number SN121b.In such an aspect, each modular component (e.g., 8204, 8206, 8208, 8210,etc.) is configured to request a communication link to a surgical hub106 of an institution. In other aspects, the surgical hub 106 may beconfigured to request a communication link with each modular component.Nonetheless, the surgical hub 106 is positioned within a communicativedistance from each modular component (e.g., in an operating room). Inone aspect of the present disclosure, a requested communication link isestablished via BLUETOOTH pairing. In other aspects of the presentdisclosure, other forms of wireless communication (e.g., WiFi, RFID,etc.) or wired communication are contemplated. Referring again to FIG.204 , each modular component (e.g., handle 8204, modular adapter 8206,end effector 8208, staple cartridge 8210, etc.) may comprise a processorand a memory unit (not shown) that stores its respective serial number.Here, according to one aspect, once a communication link is establishedbetween the surgical hub 106 and each modular component, the identifier(e.g., serial number) associated with each modular component istransmitted by each modular component to the surgical hub 106 (e.g., viathe same form or different forms of wired/wireless communication). Inone alternative aspect, in light of FIG. 204 , a modular component(e.g., modular adapter 8206, end effector 8208, and/or staple cartridge8210, etc.) may transmit its respective identifier (e.g., serial number)to another modular component (e.g., handle 8204) that transmits/relaysall identifier(s) to the surgical hub 106. Here, similar to above, thesame form or different forms of wired/wireless communication may beused. For example, each of the modular adapter 8206, the end effector8208 and the staple cartridge 8210 may transmit its respectiveidentifier (e.g., 8216, 8218, 8220) to the handle 8204 via RFID and thehandle 8204 may relay such identifiers (e.g., 8216, 8218, 8220) alongwith its own identifier 8214, via BLUETOOTH, to the surgical hub 106. Inone aspect, once the surgical hub 106 has received all identifiers forall modular components, the surgical hub 106 may transmit theidentifiers to the cloud-based analytics system (e.g., comprisingcloud-based system 105).

In various aspects of the present disclosure, the memory unit of eachmodular component may be configured to store more than its identifier.In one aspect of the present disclosure, each modular component (e.g.,8204, 8206, 8208, 8210, etc.) may further comprise a counter (not shown)configured to track a usage parameter of the modular component and itsmemory unit may be configured to store that usage parameter. In anotheraspect, the memory unit of each respective modular component may befurther configured to store a usable life metric. Such a usable lifemetric may be stored during manufacture of the modular component. Forexample, in view of FIG. 204 , the memory unit of the handle 8204 maystore both the usage parameter (e.g., 235) and the usable life metric(e.g., 400). In such an aspect, the handle 8204 has been used 235 timesout of its usable life of 400 uses. Similarly, in view of FIG. 204 , themodular adapter has been used 103 times out of its usable life of 100uses, and the end effector has been used 5 times out of its usable lifeof 12 uses. Here, similar to above, once a communication link isestablished with the surgical hub 106, the identifier, usage parameterand/or usable life metric stored in the memory unit of each modularcomponent may be transmitted directly from each modular component to thesurgical hub 106 or indirectly via another modular component. Inaddition, similar to above, the same form or different forms ofwired/wireless communication may be used. In one aspect, once thesurgical hub 106 has received all identifiers for all modularcomponents, the surgical hub 106 may transmit the identifiers to thecloud-based analytics system (e.g., comprising cloud-based system 105).

In an alternative aspect of the present disclosure, the memory unit ofeach modular component may not store its usage parameter and/or theusable life metric. In such an aspect, the usage parameter and/or theusable life metric may be stored in a database or other memory (see FIG.10 , e.g., 248/249) at the surgical hub 106/206. In such an aspect, thesurgical hub 106 may comprise a counter configured to track a usageparameter of each modular component in inventory. Furthermore, thesurgical hub 106 may be configured to download usable life metrics(e.g., from a manufacturer server) based on the identifier (e.g., serialnumber) received from each modular component. In various aspects,storage at the surgical hub 106 may be preferred to minimize memory unitrequirements in each modular component and/or to avoid any concernsregarding the tampering with and/or the alteration of usage parametersand/or usable life metrics stored at the modular component level (e.g.,altering a memory unit of a modular component to reset a usage parameterand/or increase a usable life metric, etc.).

In one example, in aspects where the memory unit of each modularcomponent stores its usage parameter and/or usable life metric, thesurgical hub 106 may also store/track the usage parameter and/or usablelife metric associated with each modular component in its inventory. Insuch an example, if a usage parameter and/or a usable life metrictransmitted from a modular component differs from a usage parameterand/or a usable life metric stored/tracked at the surgical hub 106, thesurgical hub 106 may flag the discrepancy and modify the status of thatmodular component (e.g., to unavailable, to unauthorized, to unusable,etc.).

In another alternative aspect, the memory unit of each modular componentmay not store its usage parameter and/or the usable life metric. In suchan aspect, the usage parameter and/or the usable life metric may bestored in a database (e.g., aggregated medical data database 7012 inFIG. 180 ) at a cloud-based analytics system. In such an aspect, thecloud-based analytics system may comprise a counter configured to tracka usage parameter of each modular component in inventory at eachsurgical hub. Furthermore, the cloud-based analytics system may beconfigured to download usable life metrics (e.g., from a manufacturerserver) based on the identifier (e.g., a serial number) received fromeach modular component (e.g., via a surgical hub). Alternatively, thecloud-based analytics system may download a file comprising allidentifiers for all modular components (e.g., from a plurality ofmanufacturers) wherein each identifier is associated with a usable lifemetric. Here, the cloud-based analytics system may be configured tolook-up a received identifier to determine each respective usable lifemetric. In various aspects, storage at the cloud-based analytics systemmay be preferred to minimize memory requirements in each modularcomponent and/or to avoid any concerns regarding the tampering withand/or the alteration of usage parameters and/or usable life metrics atthe modular component level and/or at the surgical hub level (e.g.,altering memory unit of a modular component to reset a usage parameterand/or increase a usable life metric, modifying the database/memory ofthe surgical hub to reset a usage parameter and/or increase a usablelife metric). Such as aspect gives the cloud-based analytics system ofthe present disclosure more control over modular component use in theinteractive surgical system.

Looking again to FIG. 204 , the illustrated multi-component surgicaltool 235 comprises four modular components (e.g., handle 8204, modularadapter 8206, end effector 8208, and staple cartridge 8210). Suchmodular devices may comprise reusable and/or reprocessed components. Invarious aspects, each modular component must satisfy system-definedconstraints for the combined multi-component surgical tool 235 to beavailable/usable/authorized for use by the cloud-based analytics system.Notably, system-defined constraints may include restrictions other thanand/or in addition to the usable life metric discussed above. Suchsystem-defined constraints may be established at the manufacturer level,at the surgical hub level, and/or at the cloud-based analytics systemlevel. One aspect of the present disclosure comprises a user interfaceat the surgical hub and/or cloud-based analytics system to createsystem-defined constraints.

In one aspect, the surgical hub 106 may be configured to enforcesystem-defined constraints (e.g., lockout at the hub level). In such anaspect, this may be preferred so that the surgical hub 106 is a localgateway to accessing the cloud-based analytics system. In anotheraspect, the cloud-based analytics system (e.g., comprising cloud-basedsystem 105) may be configured to enforce system-defined constraints(e.g., lockout at the cloud-based analytics system level). In such anaspect, this may be preferred to maintain control over all surgical hubscommunicatively coupled to the cloud-based analytics system (e.g., atone institution or at multiple institutions). System-definedconstraints, similar to the usable life metric, may be associated withthe identifier of each modular component. For example, a system-definedconstraint associated with a modular component may include an expirationdate, a requirement that an identifier (e.g., serial number) is asystem-recognizable identifier (e.g., not counterfeit), and/or flexiblesystem-defined constraints (e.g., constraints deemed non-critical untila threshold is met and the constraint is deemed critical). In one aspectof the present disclosure, if one system-defined constraint is not met,a modular component (e.g., 8204, 8206, 8208, 8210, etc.) may be deemedunavailable/unusable/unauthorized despite beingavailable/usable/authorized based on other system-defined constraint(s)(e.g., having remaining usable life). In various aspects, one or morepredetermined system-defined constraints are non-critical system-definedconstraints. Such non-critical system-defined constraints may be waived(see FIG. 204 , e.g., 8274, manual override) to render the modularcomponent available/usable/authorized and/or may produce in a warningindicator/message (see FIG. 204 , e.g., 8244). Critical system-definedconstraints cannot be waived.

In view of FIG. 204 , an example non-critical system-defined constraintis applied (e.g., by the surgical hub 106 and/or the cloud-basedanalytics system) to the handle 8204. Here, although the handle 8204 has165 remaining uses (usable life metric less determined usage parameter,e.g., 400−235) an expiration date associated with its identifier 8214(e.g., SN135b) indicates that the handle's control program isout-of-date. In such an aspect, an interface 8200 may be displayed toshow a current status of the handle 8204 (see FIG. 204 , e.g., “Count235/400” and/or “Out-of-Date”). More specifically, the interface 8200may comprise a grid including fields defined by columns and rows. In oneexample, the modular components of a proposed multi-component surgicaltool 235 may be presented (e.g., in an exploded, unassembled view)across the columns of the grid in a first row 8201 and a current/updatedstatus associated with each modular component may be presented acrosscorresponding columns of the grid in a second row 8202. As such, inaccordance with the example, status field 8224 of the interface 8200corresponds to the handle 8204 and indicates its current status as“COUNT: 235/400” and “OUT-OF-DATE”. According to other aspects, thestatus field 8224 of the interface 8200 may further show the usageremaining, remaining capabilities, and/or compatibility with otherconnected modular components, etc.

According to one aspect, the interface 8200 may comprise a cloud-basedinterface (see FIG. 203 , e.g., 8104) accessible on a cloud-accessterminal of the surgical hub (via at least one of a visualization system108/208 (e.g., FIGS. 1-2 ) or a display 135/177 associated with thesurgical hub 106 (e.g., FIGS. 1-3, 7 , etc.)). According to anotheraspect, the interface 8200 may comprise only a portion(s) of the grid(e.g., status field 8224, modular component field 8234, etc.) accessibleon the physical handle 8204 itself via a user interface positioned onthe handle 8204. Further, in the context of a non-criticalsystem-defined constraint, the interface 8200 may visually indicate awarning associated with a modular component (e.g., warning indicator8244, e.g., box associated with identifier 8214 highlighted and/orencircled and/or comprises a link 8254 (e.g., “A”) in association withmodular component field 8234 of the interface 8200). In one aspect, thelink 8254 (e.g., “A”) may key to a corresponding “Description ofProblem” section of the interface 8200 (e.g., “A” “Handle Serial NumberIndicates OUT OF DATE Control Program”). In another aspect, the link8254 (e.g., “A”) may be a hyperlink to present the correspondingdescription (e.g., “A” “Handle Serial Number Indicates OUT OF DATEControl Program”) in the interface 8200. According to such aspects, aportion of the descriptive text (e.g., “OUT OF DATE”), keyed/hyperlinkedvia link 8254, may be a hyperlink/button 8264. Upon/After selection ofthe hyperlink/button 8264 a bypass interface 8274 may be presented inthe interface 8200. According to another aspect, a portion ofdescriptive text (e.g., OUT-OF-DATE) in status field 8224 may be ahyperlink/button 8284 to, upon/after selection, directly present thebypass interface 8274 in the interface 8200. Such an aspect may bebeneficial/more efficient if the interface 8200 is being presented via a(e.g., smaller) user interface of a modular component (e.g., handle8204). Further, according to such aspects, the interface 8200 may beconfigured to receive user input to waive (e.g., manually bypass) apredetermined, non-critical system-defined constraint (e.g., theexpiration date constraint). In the context of a non-criticalsystem-defined constraint, the bypass interface 8274 may instruct “USERINPUT NEEDED” and present a first user-interface element (e.g., “Y”button) selectable to bypass the non-critical system-defined constraint(e.g., to permit use of the handle 8204) and a second user-interfaceelement (e.g., “N” button) selectable to not bypass the non-criticalsystem-defined constraint (e.g., to inhibit use of the handle 8204).Here, a selection in the bypass interface 8274 may be transmitted toupdate the surgical hub 206 and/or the cloud-based system 205.

Next, in view of FIG. 204 , an example flexible system-definedconstraint is applied (e.g., by the surgical hub 106 and/or thecloud-based analytics system) to the modular adapter 8206. Here, themodular adapter 8206 associated with identifier 8216 (e.g., SN33b) has ausage parameter of 103 (e.g., already 3 times over its suggested usablelife metric of 100 uses). In this example, the exceeding use is deemednon-critical until a 10% overage threshold is met (e.g., 110% of thesuggested 100 uses, or 110 uses) and the exceeding use is deemedcritical. In such an aspect an interface 8200 may be displayed to show acurrent status of the modular adapter 8206 (see FIG. 204 , e.g., “COUNT:103/100” “EXCEEDS”). More specifically, in accordance with the exampledescribed above, status field 8226 corresponds to the modular adapter8206 and indicates its current status as “COUNT: 103/100” and “EXCEEDS”.According to other aspects the status field 8226 of the interface 8200may further show overage remaining, remaining capabilities, and/orcompatibility with other connected modular components.

Again, according to one aspect the interface 8200 may comprise acloud-based interface (see FIG. 203 , e.g., 8104) accessible on acloud-access terminal of the surgical hub (via at least one of avisualization system 108/208 (e.g., FIGS. 1-2 ) or a display 135/177associated with the surgical hub 106 (e.g., FIGS. 1-3, 7 , etc.)).According to another aspect, the interface 8200 may comprise only aportion(s) of the grid (e.g., the status field 8226, modular componentfield 8236, etc.) accessible directly on the physical modular adapter8206 itself via a user interface positioned on the modular adapter 8206and/or indirectly on the physical handle 8204 itself via a userinterface positioned on the handle 8204. Further, in the context of aflexible system-defined constraint, the interface 8200 may visuallyindicate a warning associated with a modular component (e.g., warningindicator 8246, e.g., description of current status encircled and/orcomprises a link 8256 (e.g., “B”) in association with status field 8226of the interface 8200). In one aspect, the link 8256 (e.g., “B”) may keyto a corresponding “Description of Problem” section of the interface8200 (e.g., “B” “Modular Adapter EXCEEDS Suggested Life Limit”). Inanother aspect, the link 8256 (e.g., “B”) may be a hyperlink to presentthe corresponding description (e.g., “B” “Modular Adapter EXCEEDSSuggested Life Limit”) in the interface 8200. According to such aspects,a portion of the descriptive text (e.g., “EXCEEDS”), keyed/hyperlinkedvia link 8256, may be a hyperlink/button 8266. Upon/After selection ofthe hyperlink/button 8266 a warning interface 8276 may be presented inthe interface 8200. According to another aspect, a portion ofdescriptive text (e.g., EXCEEDS) in status field 8226 may be ahyperlink/button 8286 to, upon/after selection, directly present thewarning interface 8276 in the interface 8200. Such an aspect may bebeneficial/more efficient if the interface 8200 is being presented via a(e.g., smaller) user interface of a modular component (e.g., modularadapter 8206 and/or handle 8204). Further, according to such aspects,the interface 8200 may be configured to present a warning that themodular adapter 8206 is approaching its overage threshold. In oneaspect, the warning interface 8276 may instruct “NO INPUT NEEDED” andpresent a warning indicating that the overage threshold is beingapproached (e.g., “Approaching 10% Limit Warning”). In other aspects,the warning may indicate how many uses remain until the overagethreshold is met (e.g., “7 Uses Until 10% Overage Limit Is Met”).

Next, in view of FIG. 204 , an example system-defined constraint isapplied (e.g., by the surgical hub 106 and/or the cloud-based analyticssystem) to the end effector 8208. Here, the end effector 8208 associatedwith identifier 8218 (e.g., SN1a) has a usage parameter of 5 (e.g., 7uses under its suggested usable life metric of 12 uses remain). As such,in accordance with this example, the system-defined constraint is deemedsatisfied and the end effector 8208 is renderedavailable/usable/authorized. In such an aspect, an interface 8200 may bedisplayed to show a current status of the end effector 8208 (see FIG.204 , e.g., “COUNT: 5/12”). More specifically, in accordance with theexample described above, status field 8228 corresponds to the modularadapter 8208 and indicates its current status as “COUNT: 5/12”.According to other aspects the status field 8228 of the interface 8200may further show usage remaining, remaining capabilities, and/orcompatibility with other connected modular components.

Yet again, according to one aspect, the interface 8200 may comprise acloud-based interface (see FIG. 203 , e.g., 8104) accessible on acloud-access terminal of the surgical hub (via at least one of avisualization system 108/208 (e.g., FIGS. 1-2 ) or a display 135/177associated with the surgical hub 106 (e.g., FIGS. 1-3, 7 , etc.)).According to another aspect, the interface 8200 may comprise only aportion(s) of the grid (e.g., the status field 8228, modular componentfield 8238, etc.) accessible directly on the physical end effector 8208itself via a user interface positioned on the end effector 8208 and/orindirectly on the physical handle 8204 itself via a user interfacepositioned on the handle 8204. Here, since the system-defined constraintis satisfied, no warning interface and/or bypass interface is displayed.

Lastly, still in view of FIG. 204 , an example critical system-definedconstraint is applied (e.g., by the surgical hub 106 and/or thecloud-based analytics system) to the staple cartridge 8210. Here,identifier 8220 (e.g., SN121b), associated with the staple cartridge8210, is not a system-recognizable identifier. According to one aspect,this may occur when the surgical hub 206 and/or the cloud-basedanalytics system (e.g., comprising cloud-based system 205) is unable tomatch an identifier (e.g., serial number) received from a modularcomponent with identifiers (e.g., serial numbers) downloaded from themanufacturer(s) of the modular component(s). As such, continuing theexample, the system-defined constraint is critical, the system-definedconstraint is deemed not satisfied, and the staple cartridge 8210 isrendered unavailable/unusable/unauthorized. Further, as a result, sincethe critical system-defined constraint cannot be waived, any combinedmulti-component surgical tool comprising the staple cartridge 8210 maybe similarly rendered unavailable/unusable/unauthorized. In such asaspect, an interface 8200 may be displayed to show a current status ofthe staple cartridge 8210 (see FIG. 204 , e.g., “LOADED” “COUNTERFEIT”).More specifically, in accordance with the example described above,status field 8230 corresponds to the staple cartridge 8210 and indicatesits current status as “LOADED” and “COUNTERFEIT”.

Yet again, according to one aspect, the interface 8200 may comprise acloud-based interface (see FIG. 203 , e.g., 8104) accessible on acloud-access terminal of the surgical hub (via at least one of avisualization system 108/208 (e.g., FIGS. 1-2 ) or a display 135/177associated with the surgical hub 106 (e.g., FIGS. 1-3, 7 , etc.)).According to another aspect, the interface 8200 may comprise only aportion(s) of the grid (e.g., the status field 8230, modular componentfield 8240, etc.) accessible directly on the physical staple cartridge8210 itself via a user interface positioned on the staple cartridge 8210and/or indirectly on the physical handle 8204 itself via a userinterface positioned on the handle 8204. Further, in the context of acritical system-defined constraint, the interface 8200 may visuallyindicate a warning associated with a modular component (e.g., warningindicator 8250, e.g., box associated with identifier 8220 highlightedand/or encircled and/or comprises a link 8260 (e.g., “C”) in associationwith modular component field 8240 of the interface 8200). In one aspect,the link 8260 (e.g., “C”) may key to a corresponding “Description ofProblem” section of the interface 8200 (e.g., “C” “Serial Number ofCartridge Indicates COUNTERFEIT Cartridge”). In another aspect, the link8260 (e.g., “C”) may be a hyperlink to present the correspondingdescription (e.g., “C” “Serial Number of Cartridge Indicates COUNTERFEITCartridge”) in the interface 8200. According to such aspects, a portionof the descriptive text (e.g., “COUNTERFEIT”), keyed/hyperlinked vialink 8260, may be a hyperlink/button 8270. Upon/After selection of thehyperlink/button 8270 an action interface 8280 may be presented in theinterface 8200. According to another aspect, a portion of descriptivetext (e.g., COUNTERFEIT) in status field 8230 may be a hyperlink/button8290 to, upon/after selection, directly present the action interface8280 in the interface 8200. Such an aspect may be beneficial/moreefficient if the interface 8200 is being presented via a (e.g., smaller)user interface of a modular component (e.g., staple cartridge 8210and/or handle 8204). Further, according to such aspects, the interface8200 may be configured to instruct a user to perform an action (e.g., toremove the staple cartridge 8210 associated with the identifier 8220(e.g., SN121b) and reload with a staple cartridge associated with asystem-recognizable identifier. In one aspect, the action interface 8280may instruct “ACTION REQUIRED” and present a directive “Remove &Reload”. Here, since the system-defined constraint is critical, nowarning interface and/or bypass interface is displayed. In one furtheraspect, a list of available and/or alternative modular components (e.g.,staple cartridges) may be displayed.

In a similar manner, a list (e.g., black-listed devices) of surgicaltools (e.g., wireless surgical devices/instruments 235) and/or modularcomponents (e.g., handles, modular adapters, end effectors, staplecartridges, etc.) may be declared unavailable/unusable/unauthorized tocommunicate with and/or access the surgical hub 206 and/or cloud-basedanalytics system (e.g., comprising cloud-based system 205). In oneaspect of the present disclosure, such black-listed devices may compriseinventory items that are known and/or established to be counterfeit,defective, damaged, beyond their usable life, expired, unsterile, etc.In such an aspect, black-listed devices may be used as criticalsystem-defined constraints (e.g., if the device is on the “black-list,”it cannot communicate with and/or access the surgical hub and/orcloud-based analytics system). In line with above, criticalsystem-defined constraints cannot be waived/bypassed. Creating and/ormaintaining such a “black-list” of devices at the surgical hub leveland/or the cloud-based analytics level, may improve safety andreliability in the operating room. In one aspect, a database (e.g.,aggregated medical data database 7012 in FIG. 180 ) at the cloud-basedanalytics system may be updated each time a counterfeit device isdetected via a surgical hub 206 (e.g., similar to the staple cartridgein FIG. 204 ). Since a plurality of surgical hubs associated with aplurality institutions may communicate with the cloud-based analyticssystem, such a database, and associated “black-list”, builds ratherquickly. Such a database at the cloud-based analytics system wouldprevent a black-listed device from being used at a different surgicalhub (e.g., a surgical hub other than the surgical hub at which thecounterfeit was initially detected) communicatively coupled to thecloud-based analytics system.

In another aspect of the present disclosure, black-listed devices mayinclude surgical tools (e.g., wireless surgical devices/instruments 235)and/or modular components (e.g., handles, modular adapters, endeffectors, staple cartridges, etc.) developed by third-parties wishingto take advantage of benefits provided by the surgical hub and/orcloud-based analytics system (e.g., various inventory control aspectsdiscussed herein). In such an aspect of the present disclosure,black-listed devices may be used as non-critical system-definedconstraints and/or flexible system-defined constraints (e.g., if thedevice is on the “black-list,” it cannot communicate with and/or accessthe surgical hub and/or cloud-based analytics system). However, contraryto the previously disclosed aspect, such non-critical system-definedconstraints and/or flexible system-defined constraints may bewaived/bypassed. In one aspect of the present disclosure, such ablack-listed device (e.g., a third-party device) may be granted accessto the surgical hub and/or cloud-based analytics system for a fee. Inone example a competitor product may be initially declared counterfeit.However, once an agreed upon fee is paid, that competitor product may begranted access to the surgical hub and/or cloud-based analytics system.In another aspect, such a black-listed device may be granted partialaccess to the surgical hub and/or cloud-based analytics system but maybe subject to established secondary system-defined constraints. Inanother aspect, such a black-listed device may be granted access to thesurgical hub and/or cloud-based analytics system but may not be able tofully function (e.g., limited functionality) when paired with thesurgical hub. Similar to above, a database (e.g., aggregated medicaldata database 7012 in FIG. 180 ) at the cloud-based analytics system maybe updated each time a previously black-listed device is granted access,partial access with secondary system-defined constraints and/or accesswith limited functionality. Since a plurality of surgical hubsassociated with a plurality institutions may communicate with thecloud-based analytics system, such a database, and its associated accesslevels, can be implemented across all communicatively coupled surgicalhubs. In all such aspects, the surgical hub and/or cloud-based analyticssystem maintains complete control over devices seeking access.

In yet another aspect of the present disclosure a database of thesurgical hub (see FIG. 10 , e.g., 248/249) and/or a database (e.g.,aggregated medical data database 7012 in FIG. 180 ) of the cloud-basedanalytics system may record each modular component and/or surgical toolidentifier (e.g., serial number) in a “used identifier list” when firstused in the system. As such, each time a new modular component and/or anew surgical tool is plugged in and/or requests communication with thesurgical hub and/or cloud-based analytics system, an identifier of thenew modular component and/or surgical tool is cross-checked with the“used identifier list.” In such an aspect, if the identifier of the newmodular component and/or the new surgical tool matches an identifieralready in the “used identifier list,” that identifier may beautomatically placed on a “black-list” (e.g., critical system-definedconstraint). Here, identifiers (e.g., serial numbers) should be unique.If an already used identifier is presented at first use multiple times,this may evidence fraud and/or counterfeit activity.

As discussed herein, various aspects of the present disclosure aredirected to the application of system-defined constraints. For example,as discussed with reference to FIG. 204 above, each modular component ofa surgical tool may be associated with an identifier and each identifiermay be associated with one or more than one parameter (e.g., usageparameter, expiration date, flexible parameter, etc.). In another aspectof the present disclosure, a surgical tool may be associated with anidentifier wherein that identifier is associated with one or more thanone parameter. In such an aspect, either the surgical tool does notcomprise modular components or the surgical tool comprises modularcomponents associated with the same identifier (e.g., serial number,activation code). Here, system-defined constraints, as discussed herein,may be applied to such a surgical tool in a similar manner.

Further, as discussed herein, various aspects of the present disclosurepertain to the identification of reusable/reprocessed devices (e.g.,modular components, surgical tools, etc.) and the display of eachreusable device's availability/readiness for a next/proposed surgicalprocedure and its operational status on a screen other than the screenof the reusable device (e.g., a screen of a cloud-access terminal of thesurgical hub). In one aspect of the present disclosure the status ofeach reusable device (e.g., status of each modular component, status ofa surgical tool, and/or overall status of combined modular componentsand/or subassemblies) is queried and/or determined when the reusabledevice connects to the system or as the reusable device connects to thesystem (e.g., to the surgical hub and/or the cloud-based analyticssystem). In another aspect of the present disclosure, once/after thereusable device is used, the surgical hub and/or cloud-based analyticssystem time-stamps the use and updates the usage of each modularcomponent and/or surgical tool in its respective database.

In further various aspects of the present disclosure, a modularcomponent and/or a surgical tool may be flagged by the surgical huband/or cloud based analytics system based on predetermined criteria. Forexample, if a modular component is incompatible with other modularcomponents, its identifier (e.g., serial number) is known to be fake,and/or it is subject to a recall, a database of the surgical hub and/orthe cloud-based analytics system may be updated to not allow use of themodular component and/or surgical tool in the system (e.g., creation ofcritical system-defined constraints). Such created system-definedconstraints may be applied as discussed herein.

In yet further aspects of the present disclosure, a modular componentand/or a surgical tool may be flagged by the surgical hub and/or cloudbased analytics system based on a previous use. For example, thesurgical hub and/or the cloud based analytics system may trackperformance of the modular component and/or the surgical tool. Here,performance results may be analyzed by the cloud-based analytics systemto inform future uses of the modular component and/or surgical tool. Forexample, if the end effector did not clamp properly or jammed in aprevious use, the end effector may be flagged in a database of thesurgical hub and/or the cloud-based analytics system (e.g.,black-listed) so that the end effector cannot be used again in thesystem.

Various aspects of the present disclosure are also directed to acloud-based analytics system that generates a cloud interface for aclient care institution. More specifically, aspects of the presentdisclosure pertain to a cloud-based system including a client careinstitution surgical hub coupleable with a plurality of inventory items(e.g., handles, modular adapters, end effectors, staple cartridges,etc.) and a cloud-based analytics system. The surgical hub may include aprocessor programmed to communicate with the plurality of inventoryitems and the cloud-based analytics system. The cloud-based analyticssystem may include a processor programmed to i) receive, via thesurgical hub, data associated with the plurality of inventory items,wherein the received data comprises a unique identifier for eachinventory item, ii) determine whether each inventory item is availablefor use based on its respective unique identifier and system-definedconstraints, wherein the system-defined constraints comprise at leastone use restriction, iii) generate a cloud interface for theinstitution, wherein the institution's cloud interface comprises aplurality of user-interface elements, wherein at least oneuser-interface element enables the institution to select one or morethan one surgical procedure to be performed, and wherein after selectionof a surgical procedure, via the at least one user-interface element,the availability of each inventory item associated with the selectedsurgical procedure is dynamically generated on the institution's cloudinterface, and iv) display an alert for each inventory item determinedas not available based on the system-defined constraints, wherein thealert is displayable on at least one of the institution's cloudinterface or the inventory item. Here, in line with the disclosureherein, alternative inventory items for unavailable items may also bedisplayed. Such a cloud interface enables an institution to evaluatewhether a desired/proposed surgical procedure can proceed based oncurrent inventories. Here, data at the surgical hub level (e.g.,historical local usage) and/or the cloud-based analytics system level(e.g., historical local and/or global usage) may be used to determinecombinations of modular components and/or surgical tools usable for thesurgical procedure selected via the user-interface element. Furthermore,alternative and/or preferred modular components and/or surgical toolsmay be recommended for the surgical procedure selected via theuser-interface element. Such a recommendation (e.g., best practices) maybe based on a statistical analysis of data at the surgical hub leveland/or the cloud-based analytics system level. Such a recommendation mayor may not be based on current inventory of the institution.

In yet another aspect of the present disclosure, a modular componentand/or surgical tool may be a single-use device rather than a reusableand/or reprocessed device. In such an aspect, packaging associated withthe single-use device may include a one-time use activation code. Insuch an aspect, the one-time use activation code may be entered into anactivation input field on a cloud interface via the cloud-accessterminal of the surgical hub and transmitted to the cloud-basedanalytics system. Here, upon receipt, the cloud-based analytics systemmay cross-check the one-time use activation code with a database ofone-time use activation codes (e.g., downloaded from a manufacturer) toauthorize use with the system. If the one-time use activation codematches an unused activation code, the modular component and/or surgicaltool is authorized. However, if the one-time use activation code doesnot match an activation code in the database or the one-time useactivation code matches an already used activation code, that one-timeuse activation code may be placed on a black-list such that thesingle-use modular component and/or surgical tool is not authorized(e.g., critical system-defined constraint).

Robotic Systems

Aspects of the present disclosure also include detailed description ofvarious robotic surgical devices and systems that are configured tointerface with a Hub system, which may ultimately be interconnected tothe cloud-based medical analytics system. The combination of multipleHub systems, each communicatively coupled to a robotic surgical system,with the Hub systems communicatively coupled to the cloud-based medicalanalytics system, forms a comprehensive digital medical system that iscapable of servicing a great number of patients while providing improvedcare and insights through the aggregation and analysis of data providedby each of the multiple Hub systems and respectively coupled roboticsurgical systems. Described below are examples of structures andfunctions of various robotic surgical devices and systems configured tointegrate with this comprehensive digital medical system.

Robotic surgical systems can be used in minimally invasive medicalprocedures. During such medical procedures, a patient can be placed on aplatform adjacent to a robotic surgical system, and a surgeon can bepositioned at a console that is remote from the platform and/or from therobot. For example, the surgeon can be positioned outside the sterilefield that surrounds the surgical site. The surgeon provides input to auser interface via an input device at the console to manipulate asurgical tool coupled to an arm of the robotic system. The input devicecan be a mechanical input devices such as control handles or joysticks,for example, or contactless input devices such as optical gesturesensors, for example.

The robotic surgical system can include a robot tower supporting one ormore robotic arms. At least one surgical tool (e.g. an end effectorand/or endoscope) can be mounted to the robotic arm. The surgicaltool(s) can be configured to articulate relative to the respectiverobotic arm via an articulating wrist assembly and/or to translaterelative to the robotic arm via a linear slide mechanism, for example.During the surgical procedure, the surgical tool can be inserted into asmall incision in a patient via a cannula or trocar, for example, orinto a natural orifice of the patient to position the distal end of thesurgical tool at the surgical site within the body of the patient.Additionally or alternatively, the robotic surgical system can beemployed in an open surgical procedure in certain instances.

A schematic of a robotic surgical system 15000 is depicted in FIG. 205 .The robotic surgical system 15000 includes a central control unit 15002,a surgeon's console 15012, a robot 15022 including one or more roboticarms 15024, and a primary display 15040 operably coupled to the controlunit 15002. The surgeon's console 15012 includes a display 15014 and atleast one manual input device 15016 (e.g., switches, buttons, touchscreens, joysticks, gimbals, etc.) that allow the surgeon totelemanipulate the robotic arms 15024 of the robot 15022. The readerwill appreciate that additional and alternative input devices can beemployed.

The central control unit 15002 includes a processor 15004 operablycoupled to a memory 15006. The processor 15004 includes a plurality ofinputs and outputs for interfacing with the components of the roboticsurgical system 15000. The processor 15004 can be configured to receiveinput signals and/or generate output signals to control one or more ofthe various components (e.g., one or more motors, sensors, and/ordisplays) of the robotic surgical system 15000. The output signals caninclude, and/or can be based upon, algorithmic instructions which may bepre-programmed and/or input by the surgeon or another clinician. Theprocessor 15004 can be configured to accept a plurality of inputs from auser, such as the surgeon at the console 15012, and/or may interfacewith a remote system. The memory 15006 can be directly and/or indirectlycoupled to the processor 15004 to store instructions and/or databases.

The robot 15022 includes one or more robotic arms 15024. Each roboticarm 15024 includes one or more motors 15026 and each motor 15026 iscoupled to one or more motor drivers 15028. For example, the motors15026, which can be assigned to different drivers and/or mechanisms, canbe housed in a carriage assembly or housing. In certain instances, atransmission intermediate a motor 15026 and one or more drivers 15028can permit coupling and decoupling of the motor 15026 to one or moredrivers 15028. The drivers 15028 can be configured to implement one ormore surgical functions. For example, one or more drivers 15028 can betasked with moving a robotic arm 15024 by rotating the robotic arm 15024and/or a linkage and/or joint thereof. Additionally, one or more drivers15028 can be coupled to a surgical tool 15030 and can implementarticulating, rotating, clamping, sealing, stapling, energizing, firing,cutting, and/or opening, for example. In certain instances, the surgicaltools 15030 can be interchangeable and/or replaceable. Examples ofrobotic surgical systems and surgical tools are further describedherein.

The reader will readily appreciate that the computer-implementedinteractive surgical system 100 (FIG. 1 ) and the computer-implementedinteractive surgical system 200 (FIG. 9 ) can incorporate the roboticsurgical system 15000. Additionally or alternatively, the roboticsurgical system 15000 can include various features and/or components ofthe computer-implemented interactive surgical systems 100 and 200.

In one exemplification, the robotic surgical system 15000 can encompassthe robotic system 110 (FIG. 2 ), which includes the surgeon's console118, the surgical robot 120, and the robotic hub 122. Additionally oralternatively, the robotic surgical system 15000 can communicate withanother hub, such as the surgical hub 106, for example. In one instance,the robotic surgical system 15000 can be incorporated into a surgicalsystem, such as the computer-implemented interactive surgical system 100(FIG. 1 ) or the computer-implemented interactive surgical system 200(FIG. 9 ), for example. In such instances, the robotic surgical system15000 may interact with the cloud 104 or the cloud 204, respectively,and the surgical hub 106 or the surgical hub 206, respectively. Incertain instances, a robotic hub or a surgical hub can include thecentral control unit 15002 and/or the central control unit 15002 cancommunicate with a cloud. In other instances, a surgical hub can embodya discrete unit that is separate from the central control unit 15002 andwhich can communicate with the central control unit 15002.

Another surgical robotic system is the da Vinci® surgical robotic systemby Intuitive Surgical, Inc. of Sunnyvale, Calif. An example of a systemis depicted in FIGS. 206-212 . FIG. 206 depicts a minimally invasiverobotic surgical (MIRS) system 12010 typically used for performing aminimally invasive diagnostic or surgical procedure on a patient 12012who is lying down on an operating table 12014. The system 12010 includesa surgeon's console 12016 for use by a surgeon 12018 during theprocedure. One or more assistants 12020 may also participate in theprocedure. The MIRS system 12010 can further include a patient side cart12022, i.e. a surgical robot, and an electronics cart 12024. Thesurgical robot 12022 can manipulate at least one removably coupled toolassembly 12026 (hereinafter referred to as a “tool”) through a minimallyinvasive incision in the body of the patient 12012 while the surgeon12018 views the surgical site through the console 12016. An image of thesurgical site can be obtained by an imaging device such as astereoscopic endoscope 12028, which can be manipulated by the surgicalrobot 12022 to orient the endoscope 12028. Various alterative imagingdevices are further described herein.

The electronics cart 12024 can be used to process the images of thesurgical site for subsequent display to the surgeon 12018 through thesurgeon's console 12016. The number of robotic tools 12026 used at onetime will generally depend on the diagnostic or surgical procedure andthe space constraints within the operating room among other factors. Ifit is necessary to change one or more of the robotic tools 12026 beingused during a procedure, an assistant 12020 may remove the robotic tool12026 from the surgical robot 12022, and replace it with another tool12026 from a tray 12030 in the operating room.

Referring primarily to FIG. 207 , the surgeon's console 12016 includes aleft eye display 12032 and a right eye display 12034 for presenting thesurgeon 12018 with a coordinated stereo view of the surgical site thatenables depth perception. The console 12016 further includes one or moreinput control devices 12036, which in turn cause the surgical robot12022 (FIG. 206 ) to manipulate one or more tools 12026 (FIG. 206 ). Theinput control devices 12036 can provide the same degrees of freedom astheir associated tools 12026 (FIG. 206 ) to provide the surgeon withtelepresence, or the perception that the input control devices 12036 areintegral with the robotic tools 12026 so that the surgeon has a strongsense of directly controlling the robotic tools 12026. To this end,position, force, and tactile feedback sensors may be employed totransmit position, force, and tactile sensations from the robotic tools12026 back to the surgeon's hands through the input control devices12036. The surgeon's console 12016 is usually located in the same roomas the patient 12012 so that the surgeon 12018 may directly monitor theprocedure, be physically present if necessary, and speak to an assistant12020 directly rather than over the telephone or other communicationmedium. However, the surgeon 12018 can be located in a different room, acompletely different building, or other remote location from the patient12012 allowing for remote surgical procedures. A sterile field can bedefined around the surgical site. In various instances, the surgeon12018 can be positioned outside the sterile field. A sterile adapter candefine a portion of the boundary of the sterile field. An example of asterile adapter for a robotic arm is described in U.S. PatentApplication Publication No. 2015/0257842, filed Mar. 17, 2015, entitledBACKUP LATCH RELEASE FOR SURGICAL INSTRUMENT, which issued on Dec. 12,2017 as U.S. Pat. No. 9,839,487, which is herein incorporated byreference in its entirety.

Referring primarily now to FIG. 208 , the electronics cart 12024 can becoupled with the endoscope 12028 and can include a processor to processcaptured images for subsequent display, such as to a surgeon on thesurgeon's console, or on another suitable display located locally and/orremotely. For example, where the stereoscopic endoscope 12028 is used,the electronics cart 12024 can process the captured images to presentthe surgeon with coordinated stereo images of the surgical site. Suchcoordination can include alignment between the opposing images and caninclude adjusting the stereo working distance of the stereoscopicendoscope. As another example, image processing can include the use ofpreviously determined camera calibration parameters to compensate forimaging errors of the image capture device, such as optical aberrations,for example.

FIG. 209 diagrammatically illustrates a robotic surgery system 12050,such as the MIRS system 12010 of FIG. 206 . As discussed herein, asurgeon's console 12052, such as the surgeon's console 12016 in FIG. 206, can be used by a surgeon to control a surgical robot 12054, such asthe surgical robot 12022 in FIG. 206 , during a minimally invasiveprocedure. The surgical robot 12054 can use an imaging device, such as astereoscopic endoscope, to capture images of the procedure site andoutput the captured images to an electronics cart 12056, such as theelectronics cart 12024 in FIG. 206 . As discussed herein, theelectronics cart 12056 can process the captured images in a variety ofways prior to any subsequent display. For example, the electronics cart12056 can overlay the captured images with a virtual control interfaceprior to displaying the combined images to the surgeon via the surgeon'sconsole 12052. The surgical robot 12054 can output the captured imagesfor processing outside the electronics cart 12056. For example, thesurgical robot 12054 can output the captured images to a processor12058, which can be used to process the captured images. The images canalso be processed by a combination of the electronics cart 12056 and theprocessor 12058, which can be coupled together to process the capturedimages jointly, sequentially, and/or combinations thereof. One or moreseparate displays 12060 can also be coupled with the processor 12058and/or the electronics cart 12056 for local and/or remote display ofimages, such as images of the procedure site, or other related images.

FIGS. 210 and 211 show the surgical robot 12022 and a robotic tool12062, respectively. The robotic tool 12062 is an example of the robotictools 12026 (FIG. 206 ). The reader will appreciate that alternativerobotic tools can be employed with the surgical robot 12022 andexemplary robotic tools are described herein. The surgical robot 12022shown provides for the manipulation of three robotic tools 12026 and theimaging device 12028, such as a stereoscopic endoscope used for thecapture of images of the site of the procedure. Manipulation is providedby robotic mechanisms having a number of robotic joints. The imagingdevice 12028 and the robotic tools 12026 can be positioned andmanipulated through incisions in the patient so that a kinematic remotecenter or virtual pivot is maintained at the incision to minimize thesize of the incision. Images of the surgical site can include images ofthe distal ends of the robotic tools 12026 when they are positionedwithin the field-of-view (FOV) of the imaging device 12028. Each tool12026 is detachable from and carried by a respective surgicalmanipulator 12031, which is located at the distal end of one or more ofthe robotic joints. The surgical manipulator 12031 provides a moveableplatform for moving the entirety of a tool 12026 with respect to thesurgical robot 12022, via movement of the robotic joints. The surgicalmanipulator 12031 also provides power to operate the robotic tool 12026using one or more mechanical and/or electrical interfaces.

FIG. 212 is a schematic of a telesurgically-controlled surgical system12100. The surgical system 12100 includes a surgeon console 12102, whichfor example can be the surgeon's console 12052 (FIG. 209 ). The surgeonconsole 12102 drives a surgical robot 12104, which for example can bethe surgical robot 12022 (FIG. 206 ). The surgical robot 12104 includesa surgical manipulator 12106, which for example can be the surgicalmanipulator 12031 (FIG. 210 ). The surgical manipulator 12106 includes amotor unit 12108 and a robotic tool 12110. The motor unit 12108 is acarriage assembly that holds five motors, which can be assigned todifferent mechanisms. In some exemplifications only five motors areused, while in other exemplifications more or less than five motors canbe used. The motor unit 12108 includes a power motor 12112, a camshaftmotor 12140, a pitch motor 12116, a yaw motor 12118, and low-force gripmotor 12120, although these motors can be used for different purposesdepending on the attached instrument. Generally, each motor is anelectric motor that mechanically and electrically couples withcorresponding inputs of the robotic tool 12110. In someexemplifications, the motor unit 12108 may be located at a proximal endof the robotic tool 12110 in a shared chassis with the robotic tool, asgenerally depicted by the proximal housing shown in FIG. 211 . A motorhousing is further described in U.S. Patent Application Publication No.2012/0150192, filed Nov. 15, 2011, entitled METHOD FOR PASSIVELYDECOUPLING TORQUE APPLIED BY A REMOTE ACTUATOR INTO AN INDEPENDENTLYROTATING MEMBER, which issued on Aug. 4, 2015 as U.S. Pat. No.9,095,362, which is herein incorporated by reference in its entirety.

The robotic tool 12110 for example, can be the robotic tool 12026 (FIG.206 ) described herein. The robotic tool 12110 includes an elongatedeffector unit 12122 that includes three discrete inputs that eachmechanically couple with the pitch motor 12116, the yaw motor 12118, andthe low-force grip motor 12120, respectively, by way of the surgicalmanipulator 12106. The robotic tool 12110 also includes a transmission12124, which mechanically couples with the power motor 12112 and thecamshaft motor 12140. Examples of tools are further described inInternational Patent Application Publication No. WO 2015/153642, filedMar. 31, 2015, entitled SURGICAL INSTRUMENT WITH SHIFTABLE TRANSMISSION,and in International Patent Application Publication No. WO 2015/153636,filed Mar. 31, 2015, entitled CONTROL INPUT ACCURACY FOR TELEOPERATEDSURGICAL INSTRUMENT, each of which is herein incorporated by referencein its entirety.

A surgical end effector 12126 is located at the distal end of theeffector unit 12122. The surgical end effector 12126 and effector unit12122 are connected by way of a moveable wrist. An example of such awrist is shown at U.S. Patent Application Publication No. 2011/0118708,filed Nov. 12, 2010, entitled DOUBLE UNIVERSAL JOINT, and in U.S. Pat.No. 9,216,062, filed Feb. 15, 2012, entitled SEALS AND SEALING METHODSFOR A SURGICAL INSTRUMENT HAVING AN ARTICULATED END EFFECTOR ACTUATED BYA DRIVE SHAFT, each of which is herein incorporated by reference in itsentirety. In simplistic terms, the surgical end effector can becharacterized by a plurality of discrete but interrelated mechanisms,with each mechanism providing a degree of freedom (DOF) for the surgicalend effector 12126. As used herein with respect to surgical system12100, a DOF is one or more interrelated mechanisms for affecting acorresponding movement. The DOFs endow the surgical end effector 12126with different modes of operation that can operate concurrently ordiscretely. For example, the wrist enables the surgical end effector12126 to pitch and yaw with respect to the surgical manipulator 12106,and accordingly includes a pitch DOF 12128 and a yaw DOF 12130. Thesurgical end effector 12126 also includes a roll DOF 12132 rotatingsurgical end effector 12126 about an elongated axis. Different robotictool can have different DOFs, as further described herein.

The surgical end effector 12126 may include a clamping and cuttingmechanism, such as a surgical stapler. An example of such an instrument,including a staple cartridge therefor, is further described in U.S.Patent Application Publication No. 2013/0105552, filed Oct. 26, 2012,entitled CARTRIDGE STATUS AND PRESENCE DETECTION, and U.S. PatentApplication Publication No. 2013/0105545, filed Oct. 26, 2012, entitledSURGICAL INSTRUMENT WITH INTEGRAL KNIFE BLADE, both of which areincorporated by reference herein in their respective entireties. Aclamping mechanism can grip according to two modes, and accordinglyinclude two DOFs. A low-force DOF 12134 (e.g., a cable actuatedmechanism) operates to toggle the clamp with low force to gentlymanipulate tissue. The low-force DOF 12134 is useful for staging thesurgical end effector for a cutting or stapling operation. A high-forceDOF 12136 (e.g., a lead screw actuated mechanism) operates to furtheropen the clamp or close the clamp onto tissue with relatively highforce, for example, to tourniquet tissue in preparation for a cutting orstapling operation. Once clamped, the surgical end effector 12126employs a tool actuation DOF 12138 to further affect the tissue, forexample, to affect tissue by a stapling, cutting, and/or cauterizingdevice. Clamping systems for a surgical end effector are furtherdescribed in U.S. Pat. No. 9,393,017, filed May 15, 2012, entitledMETHODS AND SYSTEMS FOR DETECTING STAPLE CARTRIDGE MISFIRE OR FAILURE,which issued on Jul. 19, 2016, U.S. Pat. No. 8,989,903, filed Jan. 13,2012, entitled METHODS AND SYSTEMS FOR INDICATING A CLAMPING PREDICTION,which issued on Mar. 2, 2015, and U.S. Pat. No. 9,662,177, filed Mar. 2,2015, entitled METHODS AND SYSTEMS FOR INDICATING A CLAMPING PREDICTION,which issued on May 30, 2017, all of which are incorporated by referenceherein in their respective entireties.

As shown in FIG. 212 , the pitch motor 12116, the yaw motor 12118, andthe low-force grip motor 12120 drive the pitch DOF 12128, the yaw DOF12130, and the low-force grip DOF 12134, respectively. Accordingly, eachof the pitch DOF 12128, the yaw DOF 12130, and the low force grip DOF12134 is discretely paired with a motor, and can operate independentlyand concurrently with respect to other DOFs. However, the high forcegrip DOF 12136, the roll DOF 12132, and the tool actuation DOF 12138share a single input with the power motor 12112, via the transmission12124. Accordingly, only one of the high-force grip DOF 12136, the rollDOF 12132, and the tool actuation DOF 12138 can operate at one time,since coupling with the power motor 12112 occurs discretely. Thecamshaft motor 12140 is actuated to shift output of the power motor12112 between the high force grip DOF 12136, the roll DOF 12132, and thetool actuation DOF 12138. Accordingly, the transmission 12124advantageously allows a greater amount of DOFs than an arrangement whereeach motor is dedicated to a single DOF.

Additional features and operations of a surgical robotic system, such asthe robotic surgical system of FIGS. 206-212 , are further described inthe following references, which are herein incorporated by reference intheir respective entireties:

-   -   U.S. Patent Application Publication No. 2011/0118708, filed Nov.        12, 2010, entitled DOUBLE UNIVERSAL JOINT;    -   U.S. Pat. No. 9,095,362, filed Nov. 15, 2011, entitled METHOD        FOR PASSIVELY DECOUPLING TORQUE APPLIED BY A REMOTE ACTUATOR        INTO AN INDEPENDENTLY ROTATING MEMBER, which issued on Aug. 4,        2015;    -   U.S. Pat. No. 8,989,903, filed Jan. 13, 2012, entitled METHODS        AND SYSTEMS FOR INDICATING A CLAMPING PREDICTION, which issued        on Mar. 24, 2015;    -   U.S. Pat. No. 9,216,062, filed Feb. 15, 2012, entitled SEALS AND        SEALING METHODS FOR A SURGICAL INSTRUMENT HAVING AN ARTICULATED        END EFFECTOR ACTUATED BY A DRIVE SHAFT, which issued on Dec. 22,        2015;    -   U.S. Pat. No. 9,393,017, filed May 15, 2012, entitled METHODS        AND SYSTEMS FOR DETECTING STAPLE CARTRIDGE MISFIRE OR FAILURE,        which issued on Jul. 19, 2016;    -   U.S. Patent Application Publication No. 2013/0105552, filed Oct.        26, 2012, entitled CARTRIDGE STATUS AND PRESENCE DETECTION;    -   U.S. Patent Application Publication No. 2013/0105545, filed Oct.        26, 2012, entitled SURGICAL INSTRUMENT WITH INTEGRAL KNIFE        BLADE;    -   International Patent Application Publication No. WO 2015/142814,        filed Mar. 17, 2015, entitled SURGICAL CANNULA MOUNTS AND        RELATED SYSTEMS AND METHODS;    -   U.S. Patent Application Publication No. 2015/0257842, filed Mar.        17, 2015, entitled BACKUP LATCH RELEASE FOR SURGICAL INSTRUMENT,        which issued on Dec. 12, 2017 as U.S. Pat. No. 9,839,487;    -   U.S. Patent Application Publication No. 2015/0257841, filed Mar.        17, 2015, entitled LATCH RELEASE FOR SURGICAL INSTRUMENT;    -   International Patent Application Publication No. WO 2015/153642,        filed Mar. 31, 2015, entitled SURGICAL INSTRUMENT WITH SHIFTABLE        TRANSMISSION;    -   International Patent Application Publication No. WO 2015/153636,        filed Mar. 31, 2015, entitled CONTROL INPUT ACCURACY FOR        TELEOPERATED SURGICAL INSTRUMENT; and    -   U.S. Pat. No. 9,662,177, filed Mar. 2, 2015, entitled METHODS        AND SYSTEMS FOR INDICATING A CLAMPING PREDICTION, which issued        on May 30, 2017.

The robotic surgical systems and features disclosed herein can beemployed with the da Vinci® surgical robotic system referenced hereinand/or the system of FIGS. 206-212 . The reader will further appreciatethat various systems and/or features disclosed herein can also beemployed with alternative surgical systems including thecomputer-implemented interactive surgical system 100, thecomputer-implemented interactive surgical system 200, the roboticsurgical system 110, the robotic hub 122, the robotic hub 222, and/orthe robotic surgical system 15000, for example.

In various instances, a robotic surgical system can include a roboticcontrol tower, which can house the control unit of the system. Forexample, the processor 12058 (FIG. 209 ) can be housed within a roboticcontrol tower. The robotic control tower can comprise a robot hub suchas the robotic hub 122 (FIG. 2 ) or the robotic hub 222 (FIG. 9 ), forexample. Such a robotic hub can include a modular interface for couplingwith one or more generators, such as an ultrasonic generator and/or aradio frequency generator, and/or one or more modules, such as animaging module, a suction module, an irrigation module, a smokeevacuation module, and/or a communication module.

A robotic hub can include a situational awareness module, which can beconfigured to synthesize data from multiple sources to determine anappropriate response to a surgical event. For example, a situationalawareness module can determine the type of surgical procedure, step inthe surgical procedure, type of tissue, and/or tissue characteristics,as further described herein. Moreover, such a module can recommend aparticular course of action or possible choices based on the synthesizeddata. In various instances, a sensor system encompassing a plurality ofsensors distributed throughout the robotic system can provide data,images, and/or other information to the situational awareness module.Such a situational awareness module can be accessible to the processor12058, for example. In various instances, the situational awarenessmodule can obtain data and/or information from a non-robotic surgicalhub and/or a cloud, such as the surgical hub 106 (FIG. 1 ), the surgicalhub 206 (FIG. 10 ), the cloud 104 (FIG. 1 ), and/or the cloud 204 (FIG.9 ), for example. Situational awareness of a surgical system is furtherdisclosed herein and in U.S. Provisional Patent Application Ser. No.62/611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017,and in U.S. Provisional Patent Application Ser. No. 62/611,340, entitledCLOUD-BASED MEDICAL ANALYTICS, filed Dec. 28, 2017, the disclosure ofeach of which is herein incorporated by reference in its entirety.

Surgical systems including a robot, a visualization system (such as thevisualization system 108 or the visualization system 208), and one ormore hubs (such as the hub 106, the robotic hub 122, the hub 206, and/orthe robotic hub 222) can benefit from robust communication systems fordata collection and dissemination. For example, various parametersregarding the surgical site, the surgical instrument(s), and/or thesurgical procedure can be important information to the robot, thevisualization system, and the hub(s). Moreover, the robot can includeone or more subassemblies, such as a control console, which may requireinformation regarding the surgical site, the surgical instrument(s),and/or the surgical procedure, for example. It can be helpful to collectand disseminate the information to the appropriate assemblies and/orsubassemblies in real-time or near real-time to inform the machinelearning and/or decision-making process, for example. In certaininstances, data collection and dissemination can inform the situationalawareness of a surgical system that includes one or more roboticsystems.

In one aspect, a robotic surgical system can include additionalcommunication paths. For example, a robotic surgical system can includea primary wired communication path and a secondary wirelesscommunication path. In certain instances, the two communication pathscan be independent such that a secondary path is redundant and/orparallel to a primary path. In various instances, a first type and/oramount of data can be transferred along the primary path and a secondtype and/or amount of data can be transferred along the secondary path.The multiple communication paths can improve connectivity of the robotand/or the robotic surgical tools to one or more displays within thesurgical theater, a control console, and/or control unit. Thecommunication paths can connect a surgical robot to a central controlunit (e.g. a hub) and/or a visualization system (e.g. a display), forexample. In various instances, the additional communication paths canprovide additional data to the robot and/or to a generator module and/ora processor in communication with the generator module.

Referring primarily to FIG. 213 , a robotic surgical system 12200including a console 12216 and a robot 12222 is depicted. The console12216 can be similar in many respects to the console 12016 (FIGS. 206and 207 ), and the robot 12222 can be similar in many respects to therobot 12022 (FIGS. 206 and 210 ). A robotic tool 12226, which can besimilar in many respects to the robotic tool 12026 (FIG. 206 ), forexample, is positioned at the distal end of one of the arms of the robot12222. The robotic tool 12226 is an energy device. For example, energycan be supplied to the robotic tool 12226 by a generator that is coupledto the robotic tool 12226.

The robotic surgical system 12200 also includes a hub 12224, which canbe similar in many respects to the robotic hub 122 (FIG. 2 ) and/or therobotic hub 222 (FIG. 9 ). The hub 12224 includes a generator module12230, which is similar in many respects to the generator module 140(FIG. 3 ), and a wireless communication module 12238, which is similarin many respects to the communication module 130 (FIG. 3 ). Thegenerator module 12230 is configured to supply energy to the robotictool 12226 via a first wired connection 12244.

In one instance, the first wired connection 12244 can be a two-waycommunication path between the robotic tool 12226 and the surgical hub12224. The first wired connection 12244 can convey advanced energyparameters or other electrical data between the robotic tool 12226 andthe surgical hub 12224. For example, the surgical hub 12224 can provideinformation to the robotic tool 12226 regarding the power level (e.g.current for an RF device and amplitude and/or frequency for anultrasonic device) supplied thereto. Additionally, the robotic tool12226 can provide information to the robot 12222 regarding the detectedconductivity and/or impendence at the tissue interface, corresponding toa property of the tissue and/or the effectiveness of the energy device.

Additionally, a second wired connection 12240 between the console 12216and the robotic tool 12226 mounted to the robot 12222 provides acommunication path for control signals from the robot console 12216 tothe robotic tool 12226. In one instance, the second wired connection12240 can be a one-way communication path from the robot 12222 to theconsole 12216 with respect to control parameters or other mechanicaldata collected by the robot 12222 and/or the robotic tool 12226. Forexample, the robot 12222 can provide information to the console 12216about a surgical actuation of the robotic tool, such as a closing motionand/or a firing motion. More specifically, the robot can communicateforce-to-clamp parameters (e.g. clamping pressure by the robotic tool12226 on tissue) and/or force-to-fire parameters from the robotic tool12226 to the console 12216, for example.

Referring still to FIG. 213 , absent the wireless communication paths12242 and 12246, the robotic hub 12224 may be unable to communicate withthe console 12216 and vice versa. Additionally, the robotic tool 12226may be unable to communicate with the hub 12224. In instances in whichcommunication paths between the hub 12224 and the robot 12222 and/or therobotic tool 12226 are lacking, the mechanical control parameters (e.g.clamping force) from the robotic tool 12226 may not be communicated tothe robotic hub 12224 and the generator module 12230 thereof.Additionally, electrical advanced energy parameters may not becommunicated from the robot 12222 to the robotic hub 12224 and/or to theconsole 12216. In such instances, the system 12200 would compriseopen-loop controls.

Different energy parameters and different clamping pressures may bebetter suited for certain types of tissue and/or certain applications.For example, an ultrasonic weld is generally a function of transduceramplitude and clamping pressure over time. Similarly, an RF weld isgenerally a function of current and clamping pressure over time.However, without the wireless communication paths 12242 and 12246mentioned above, the generator module 12230 can be unaware of theclamping pressure. Similarly, the console 12216 can be unaware of theenergy parameters.

To optimize the control of the robotic tool 12226, the robotic tool12226 can convey one or more mechanical control parameters to therobotic hub 12224. Additionally, the hub 12224 can convey one or moreadvanced energy parameters to the console 12216. The data transfer canprovide closed-loop controls for the system 12200. In one instance, themechanical control parameters and advanced energy parameters can bebalanced for different types of tissue and/or particular applications.For example, the clamping pressure can be decreased and the power to therobotic tool 12226 can be increased, or vice versa.

Referring still to FIG. 213 , the robotic tool 12226 includes a wirelesscommunication module 12228, as further described herein. The wirelesscommunication module 12228 is in signal communication with the wirelesscommunication module 12238 of the robotic hub 12224 via the wirelesscommunication path 12242. For example, the wireless communication module12238 can include a first receiver 12232 configured to receive wirelesssignals from the robotic tool 12226. The wireless communication module12238 also includes a second receiver 12234, which can receive signalsfrom the console 12216 via the second wireless communication path 12246.In such instances, the first and second wireless communication paths12242 and 12246, respectively, can complete a communication circuit backto the console 12216 from the robotic tool 12226 via the surgical hub12224, for example.

In other instances, the wireless communication module 12228 can be onthe robot 12222. For example, the wireless communication module 12228can be positioned on an arm of the robot and/or a tool mounting portionof the robot 12222.

Additionally or alternatively, a wireless communication path can beprovided between the robotic tool 12226 and the console 12216.

The wireless paths described herein can provide data transfer withoutencumbering the mobility of the robotic tool 12226 and/or creatingadditional opportunities for entanglement or cords and/or wires. Inother instances, one or more of the wireless communication pathsdescribed herein can be replaced with wired connection(s).

In one aspect, the robotic tool 12226 and/or the hub 12224 can shareinformation regarding sensed tissue parameters (e.g. conductivity orinductance corresponding to a property of the tissue) and/or controlalgorithms for energizing the tissue (e.g. power levels), which can bebased on the sensed tissue parameters. The robotic tool 12226 canprovide information regarding the status, the activation state,identification information, and/or smart data to the hub 12224, forexample. Data provided to the hub 12224 can be stored, analyzed, and/orfurther disseminated by the hub 12224 such as to a display screen 12236thereof. In such instances, the hub 12224 is a conduit or relay post fortransmitting the data to additional locations via the wired or wirelessconnections.

In certain instances, the hub 12224 includes a situational awarenessmodule, as further described herein. The situational awareness modulecan be configured to determine and/or confirm a step in a surgicalprocedure and/or suggest a particular surgical action based oninformation received from various sources, including the robot 12222 andthe console 12216. The wireless communication paths 12242 and 12246linking the hub 12224 to the robot 12222 and the console 12216,respectively, can be configured to inform the situational awarenessmodule. For example, mechanical control parameters regarding clampingand/or firing can be communicated to the hub 12224 and the situationalawareness module thereof via the second wireless communication path12246. Additionally or alternatively, energy parameters regardingactivation of the energy tool and/or sensed tissue parameters can becommunicated to the hub 12224 and the situational awareness modulethereof via the first wireless communication path 12242.

In certain instances, the data wirelessly transmitted to the hub 12224can inform the situational awareness module thereof. For example, basedon sensed tissue parameters detected by the robotic tool 12226 andtransmitted along the first wireless communication path 12242, thesituational awareness module can determine and/or confirm the type oftissue involved in the surgical procedure and, in certain instances, cansuggest a therapeutic response based on the type of tissue encountered.

Referring still to FIG. 213 , the second wired connection 12240 from therobot 12222 to the console 12216 provides a first communication path.Moreover, the wired or wireless connection between the robot 12222 andthe hub 12224 in combination with the wireless communication path 12246between the hub 12224 and the console 12216 forms a second, parallelcommunication path from the robot 12222 to the console 12212. Becausethe second communication path communicates via the hub 12224 and thewireless communication module 12238 thereof, the second communicationpath is different than the first communication path. However, such apath provides a parallel and alternative path to the second wiredconnection 12240 between the robot 12222 and the console 12216.Similarly, parallel and/or redundant paths are also provided via thewireless path 12242 and the wired path 12244 between the robot 12222 andthe hub 12224. The alternative parallel communication path(s) canbolster the integrity of the communications systems and enables robotcommunication between the various components of the surgical system.

Additionally or alternatively, information may be communicated directlyto a device or system having wireless capabilities such as avisualization system or display like the visualization system 108 or thevisualization system 208, for example. A surgical system 12300 depictedin FIG. 238 includes the console 12216 for a surgeon S, the robot 12222including the robotic tool 12226 mounted thereto, and the surgical hub12224. The surgical system 12300 also includes a monitor 12350, which ispositioned within the surgical theater. Additional clinicians can bewithin the surgical theater including a nurse N, a medical assistant MA,and an anesthesiologist A. Certain clinicians can be positioned withinthe sterile field. For example, the nurse N, who is stationed at a table12352 supporting a plurality of medical instruments and robotic tools,can be sterile. The medical assistant MA holding the handheld surgicalinstrument and the anesthesiologist A may be positioned outside thesterile field. The monitor 12350 is viewable by clinicians within thesterile field and outside the sterile field. An additional display 12354can be positioned within the sterile field. The additional display 12354can be a mobile computer with wireless, cellular and/or Bluetoothcapabilities, for example. In one instance, the additional display 12354can be a tablet, such as an iPad® tablet, that is positionable on thepatient P or patient table 12358. In such instances, the display 12354is positioned within the sterile field.

The wireless communication module 12228 (FIG. 213 ) on the robotic tool12226 can be in signal communication with the monitor 12350 and/or thedisplay 12354. In such instances, data and/or information obtained atthe surgical site and/or by the robotic tool 12226 can be directlycommunicated to a screen within the surgical theater and immediatelyviewable to various clinicians with the surgical theater, includingclinicians within the sterile field or outside the sterile field. Insuch instances, data can be provided in real time, or near real time, toinform the clinicians' decisions during the surgical procedure.Additionally, certain information can be communicated to the hub 12224for further storage, analysis and/or dissemination, as further describedherein.

Owing to wireless communication paths, the monitor 12350 and/or thedisplay 12354 can also display information from the hub, includingenergy parameters, in certain instances. For example, the hub 12224 canobtain data indicative of an activation state or activation level of thegenerator module 12230 (FIG. 213 ) and/or can receive data indicative ofsensed tissue parameters from the robotic tool 12226, as furtherdescribed herein. In such instances, the activation information and/ortissue information can be displayed on the monitor 12350 and/or thedisplay 12354 such that the information is readily available tooperators both within the sterile filed and outside the sterile field.

In one aspect, the hub 12224 can ultimately communicate with a cloud,such as the cloud 104 or the cloud 204, for example, to further informthe machine-learning and decision-making processes related to theadvanced energy parameters and/or mechanical control parameters of therobotic tool 12226. For example, a cloud can determine an appropriatesurgical action and/or therapeutic response for a particular tissueparameter, surgical procedure, and/or patient demographic based onaggregated data stored therein. To protect patient confidentiality, thehub 12224 can communicate redacted and/or a confidential version of thedata, for example.

As described herein with respect to FIG. 213 , the robotic tool 12226includes the wireless communication module 12228. The wirelesscommunication module 12228 is also shown in FIG. 214 . Specifically, aproximal portion of the robotic tool 12226 including the wirelesscommunication module 12228 is depicted in FIG. 214 , as well as a toolmounting portion, or attachment portion, 12250 of the robot 12222 forreleasably attaching the proximal housing of the robotic tool 12226. Adetailed view of a mechanical and electrical interface between therobotic tool 12226 and the tool mounting portion 12250 is depicted inFIG. 215 .

The robotic tool 12226 includes a first drive interface 12252 thatdrivingly couples with a second drive interface 12254 on the toolmounting portion 12250. The tool mounting portion 12250 includes acarriage or motor housing that houses a plurality of motors, which canbe similar in many respects to the motors 12112, 12116, 12118, 12120,and 12140 (FIG. 212 ), for example. The motors are driving coupled torotary outputs 12256 at the second drive interface 12254 that engagerotary inputs 12258 on the robotic tool 12226. For example, the rotaryinputs 12258 are positioned and structured to mechanically mate with therotary outputs 12256 on the tool mounting portion 12250.

A plug 12260 for supplying power to the motors is shown in FIG. 214 .The plug 12260 is also coupled to the wireless communication module12228. In such instances, the wireless communication module 12228 can bepowered via a current supplied by the plug 12260. The plug 12260 canultimately be wired to the generator module 12230 in the hub 12224 tocomplete the wired connection 12244 between the robotic tool 12226 andthe hub 12224 (see FIG. 213 ).

Referring primarily now to FIG. 214 , the tool mounting portion 12250also includes electrical contacts 12262, and the robotic tool 12226includes electrical contacts 12264 positioned and structured to matewith the electrical contacts 12262 on the tool mounting portion 12250.Electrical signals can be communicated between the robotic tool 12226and the robot 12222 (FIG. 213 ) via the mating electrical contacts12262, 12264. In certain instances, mechanical control parameters fromthe robotic tool 12262 can be communicated to the robot 12222 via theelectrical contacts 12262, 12264, as further described herein.Additionally or alternatively, advanced energy parameters can becommunicated to the robot 12222 and/or to the robotic tool 12226 via themating electrical contacts 12262, 12264, or vice versa, as furtherdescribed herein.

As depicted in FIG. 215 , when the robotic tool 12226 is mounted to thetool mounting portion 12250, a flex circuit 12270 is positionedintermediate the mating electrical contacts 12264 of the robotic tool12226 and the electrical contacts 12262 of the tool mounting portion12250 to facilitate data transmission. The flex circuit 12270 ispositioned to intercept communication signals between the robotic tool12262 and the tool mounting portion 12250. In such instances, the flexcircuit 12270 is configured to capture signals passing between thosecontacts 12262, 12264. In certain instances, the flex circuit 12270 canprovide intelligence features to the robotic tool 12226.

In various instances, the flex circuit 12270 can include a feedbackpigtail connector. The pigtail connector can intercept the connectionbetween the robotic tool 12226 and the tool mounting portion 12250.

In various instances, the flex circuit 12270 of FIG. 214 can alsoinclude a wireless transmitter that is configured to communicate withthe hub 12224 (FIG. 213 ) via the wireless communication path 12242. Inother instances, the flex circuit 12270 can be coupled to a wirelesscommunication module like the module 12228 in FIGS. 213 and 214 , whichcan include a wireless transmitter and/or a wireless receiver.

The flex circuit 12270 occupies a small footprint between the toolmounting portion 12250 and the robotic tool 12226. In one aspect,existing robotic systems can be retrofit with such flex circuits. Inother words, existing robotic tools and tool mounting portion canutilize the robust communication systems described herein withoutmodifying the current robotic tools and/or tool mounting portions.

In various instances, the flex circuit 12270, or another intermediatepigtail connector, can be configured to acquire one or more signalsbetween an external controller (e.g., an energy generator of a generatormodule 140 in a hub 106 (FIG. 3 )) and the robotic tool 12226. Moreover,such a circuit or connector can be used to deliver signals to therobotic tool 12226 via the intercepting connections.

In one aspect, the robotic hub includes a processor and a memorycommunicatively coupled to the processor, as described herein. Thememory stores instructions executable by the processor to relay awireless signal between a robot and a control console, as describedherein. In certain instances, the memory stores instructions executableby the processor to adjust a control parameter of the generator (e.g.power level) based on signals intercepted by a flex circuit and/ortransmitted along a wireless communication path. Additionally oralternatively, the memory stores instructions executable by theprocessor to adjust a control parameter of the energy tool (e.g.clamping pressure) based on signals indicative of a tissue propertyintercepted by the flex circuit and/or transmitted along the wirelesscommunication path.

In various aspects, the present disclosure provides a control circuit torelay a wireless signal between a robot and a control console, adjust acontrol parameter of the generator, and/or adjust a control parameter ofan energy tool, as described herein. In various aspects, the presentdisclosure provides a non-transitory computer readable medium storingcomputer readable instructions which, when executed, cause a machine torelay a wireless signal between a robot and a control console, adjust acontrol parameter of the generator, and/or adjust a control parameter ofan energy tool, as described herein.

In one aspect, one or more features and/or effects of arobotically-controlled surgical tool and end effector thereof can becontrolled by a control algorithm. For example, the intensity of an endeffector effect can be controlled by a control algorithm stored in thememory of the robot and executable by a processor. In one instance, anend effector effect can be smoke evacuation, insufflation, and/orcooling. In another instance, an end effector effect can be articulationand/or retraction. As an example, a robot can implement a load controlholding algorithm for articulation of a robotic tool that results in apredefined lateral load on tissue and is limited by a displacementlimit, as further described herein.

In certain instances, it can be desirable to incorporate a pump into arobotically-controlled surgical tool, such as an energy tool includingan RF electrode and/or an ultrasonic blade, for example. A pump canprovide insufflation gases or air to a surgical site. In certaininstances, a pump can provide coolant to a surgical site and/or canextract smoke and/or steam from the surgical site.

Robotically-controlled surgical tools include a drive system forreleasably engaging with a robot and transferring drive motions from therobot to the robotic tool. For example, a robotically-controlledsurgical tool can include an interface including rotary driver(s)configured to receive rotary inputs from motor(s) in a motor housing ortool mounting portion. Exemplary drive systems and interfaces thereforare further described herein.

The rotary drivers in the robotic tools are configured to actuatevarious surgical functions such as rotation of a shaft, closure of endeffector jaws, and articulation of the end effector, for example.Examples of interface configurations are further described herein and inInternational Patent Application Publication No. WO 2015/153642, filedMar. 31, 2015, entitled SURGICAL INSTRUMENT WITH SHIFTABLE TRANSMISSION,in International Patent Application Publication No. WO 2015/153636,filed Mar. 31, 2015, entitled CONTROL INPUT ACCURACY FOR TELEOPERATEDSURGICAL INSTRUMENT, and in U.S. Pat. No. 9,095,362, filed Nov. 15,2011, entitled METHOD FOR PASSIVELY DECOUPLING TORQUE APPLIED BY AREMOTE ACTUATOR INTO AN INDEPENDENTLY ROTATING MEMBER, each of which isherein incorporated by reference in its entirety.

In certain instances, the number of motors, the number of rotarydrivers, and/or the arrangements of motors and/or rotary drivers can belimited or constrained by the footprint of the drive system and/orcoupling between the robotic tool and the tool mounting portion. In oneaspect, it can be desirable for new and/or improvedrobotically-controlled surgical tools to be compatible with existingrobotic platforms. For example, without enlarging the motor housing ortool mounting portion, it can be desirable to change the functionalityand/or add functionality to robotic tools for use with an existing motorhousing and tool mounting portion. In such instances, it can bechallenging to incorporate certain features, like a pump for example,into a robotic tool compatible with an existing surgical robot.Moreover, it can be desirable to include controls and/or controlalgorithms for such a pump within the existing architecture of thesurgical robot.

In one aspect, a pump for a robotic tool can be powered by a rotarydrive of the robotic tool interface. The rotary drive and, thus, thepump can be driven at a variable rate, which can depend on the needs ofthe robotic tool and/or the surgical procedure. For example, the speedof the rotary drive coupled to the pump can be related to the volume ofsmoke being evacuated from the surgical site and/or the application ofenergy to tissue by the robotic tool. In one instance, the robotic toolcan be an intelligent tool that includes a processor configured todetermine the appropriate rate for the pump based on sensors on therobotic tool and/or other inputs thereto. In other instances, aprocessor in the control unit of the robot can be configured todetermine the appropriate rate for the pump based on sensors on therobot and/or modules thereof, such as a smoke evacuation module in arobotic hub, for example.

Energy devices utilize energy to affect tissue. In an energy device, theenergy is supplied by a generator. Energy devices include devices withtissue-contacting electrodes, such as an electrosurgical device havingone or more radio frequency (RF) electrodes, and devices with vibratingsurfaces, such as an ultrasonic device having an ultrasonic blade. Foran electrosurgical device, a generator is configured to generateoscillating electric currents to energize the electrodes. For anultrasonic device, a generator is configured to generate ultrasonicvibrations to energize the ultrasonic blade.

As provided herein, energy devices deliver mechanical or electricalenergy to a target tissue in order to treat the tissue (e.g. to cut thetissue and/or cauterize blood vessels within and/or near the targettissue). The cutting and/or cauterization of tissue can result in fluidsand/or particulates being released into the air. Such fluids and/orparticulates emitted during a surgical procedure can constitute smoke,for example, which can include carbon and/or other particles suspendedin air.

In various instances, an energy tool for use with a robotic system caninclude a suction port coupled to a pump that is powered by a motor onthe tool driver. For example, an energy tool for the da Vinci® surgicalrobotic system can include a suction port coupled to a pump that ispowered by a motor on the tool driver. The pump can be configured toextract smoke from a surgical site via the suction port. In suchinstances, the energy tool can include a smoke evacuation system. In oneaspect, the robotic tool can include a pump. Alternatively, the robotictool can be coupled to a pump.

The reader will appreciate that such an evacuation system can bereferred to as a “smoke evacuation system” though such an evacuationsystem can be configured to evacuate more than just smoke from asurgical site. Throughout the present disclosure, the “smoke” evacuatedby an evacuation system is not limited to just smoke. Rather, theevacuation systems disclosed herein can be used to evacuate a variety offluids, including liquids, gases, vapors, smoke, steam, or combinationsthereon. The fluids can be biologic in origin and/or can be introducedto the surgical site from an external source during a procedure. Thefluids can include water, saline, lymph, blood, exudate, and/or pyogenicdischarge, for example. Moreover, the fluids can include particulates orother matter (e.g. cellular matter or debris) that is evacuated by theevacuation system. For example, such particulates can be suspended inthe fluid.

Referring primarily to FIGS. 216-218 , a robotic tool 12426 for use witha robotic surgical system is depicted. The robotic tool 12426 can beemployed with the robotic surgical system 12010 (FIG. 206 ), forexample. The robotic tool 12426 is a bipolar radio-frequency (RF)robotic tool. For example, the tool can be similar in many respects tothe tool disclosed in U.S. Pat. No. 8,771,270, filed on Jul. 16, 2008,entitled BIPOLAR CAUTERY INSTRUMENT, which is herein incorporated byreference in its entirety.

In other instances, the robotic tool 12426 can be a monopolar RF tool,an ultrasonic tool, or a combination ultrasonic-RF tool. For example,the robotic tool 12426 can be similar in many similar to the tooldisclosed in U.S. Pat. No. 9,314,308, filed Mar. 13, 2013, entitledROBOTIC ULTRASONIC SURGICAL DEVICE WITH ARTICULATING END EFFECTOR, whichis herein incorporated by reference in its entirety.

The robotic tool 12426 includes a proximal housing 12437, a shaft 12438extending from the proximal housing 12437, and an end effector 12428extending from a distal end of the shaft 12438. Referring primarily toFIG. 217 , the end effector 12428 includes opposing jaws 12430 a, 12430b. Each jaw 12430 a, 12430 b includes a tissue-contacting surfaceincluding an electrode. For example, the jaw 12430 a can include asupply electrode, and the jaw 12430 b can include a return electrode, orvice versa. The end effector 12428 is shown in a clamped configurationand generating an RF weld in FIG. 217 . In such instances, smoke S fromthe RF weld may accumulate around the end effector 12428. For example,the smoke S can accumulate in the abdomen of a patient in certaininstances.

The robotic tool 12426 also includes an evacuation system 12436. Forexample, to improve visibility and efficiency of the robotic tool 12426,the smoke S at the surgical site can be evacuated along an evacuationchannel, or suction conduit, 12440 extending proximally from the endeffector 12428. The evacuation channel 12440 can extend through theshaft 12438 of the robotic tool 12426 to the proximal housing 12437. Theevacuation conduit 12440 terminates at a suction port 12442 adjacent tothe end effector 12428. During operating of the evacuation system 12436,smoke S at the surgical site is drawn into the suction port 12442 andthrough the evacuation conduit 12440.

In various instances, the robotic tool 12426 can include insufflation,cooling, and/or irrigation capabilities, as well. For example, theevacuation system 12436 can be configured to selectively pump a fluid,such as saline or CO₂ for example, toward the end effector 12428 andinto the surgical site.

In various instances, the evacuation channel 12440 can be coupled to apump for drawing the smoke S along the evacuation channel 12440 withinthe shaft 12438 of the robotic tool 12426. Referring primarily to FIG.218 , the evacuation system 12436 includes a pump 12446. The pump 12446is housed in the proximal housing 12437 of the robotic tool 12426. Thepump 12446 is a lobe pump, which has been incorporated into a driveinterface 12448 of the robotic tool 12426. The drive interface 12448includes rotary drivers 12450, which are driven by rotary outputs frommotors in the tool mounting portion of the robot, as described herein(see rotary outputs 12256 (FIG. 214 ) and rotary outputs 12824 a-12824 e(FIG. 222 ), for example).

Lobe pumps can be low volume and quiet or noiseless and, thus, desirablein certain instances. For example, a lobe pump can ensure the noisegenerated by the evacuation system 12436 is not distracting to theclinicians and/or allows communication between clinicians in thesurgical theater. The reader will readily appreciate that differentpumps can be utilized by the evacuation system 12436 in other instances.

A channel 12452 terminating in a fitting 12454 extends from the pump12446 in FIGS. 216 and 218 . The fitting 12454 is a luer fitting,however, the reader will readily appreciate that alternative fittingsare envisioned. The luer fitting can be selectively coupled to areservoir that is configured to receive the smoke S from the surgicalsite, for example. Additionally or alternatively, the luer fitting cansupply discharge from the pump 12446 to a filter.

Referring still to FIG. 218 , internal components of the drive interface12448 are depicted, however, certain components are excluded forclarity. The evacuation channel 12440 extends through the shaft 12438 tothe lobe pump 12446 in the proximal housing 12437. The pump 12446 isdriven by a rotary driver 12450 of the interface 12448. In variousinstances, the interface 12448 can include four rotary drivers 12450. Inone example, a first rotary driver 12450 is configured to power anarticulation motion, a second rotary driver 12450 is configured to powera jaw closure motion, a third rotary driver 12450 is configured to powera shaft rotation, and a fourth rotary driver 12450 is configured topower the pump 12446. The reader will appreciate that alternativeinterface arrangements can include more than or less than four rotarydrivers 12450. Additionally, the drive motions generated by the rotarydrivers 12450 can vary depending on the desired functionality of therobotic tool 12426. Moreover, in certain instances, the drive interface12448 can include a transmission or shifter such that the rotary drivers12450 can shift between multiple surgical functions, as furtherdescribed herein (see transmission 12124 in FIG. 212 and transmissionassembly 12840 in FIGS. 223-228 , for example). In one instance, therotary driver 12450 coupled to the pump 12446 can also actuate aclamping motion of the end effector 12428, for example.

In one aspect, activation of the pump 12446 of the robotic tool 12426can be coordinated with the application of energy by the robotic tool12426. In various instances, a control algorithm for the rotary driver12450 for the pump 12446 can be related to the rate at which smoke S isextracted from the surgical site. In such instances, the robot (e.g. therobot 12022 in FIGS. 206 and 210 ) can have direct control over thevolume of evacuation and/or extraction from the surgical site.

In one instance, the on/off control for the pump 12446 is controlledbased on inputs from a camera, such as the camera of the imaging device124 (FIG. 2 ) like an endoscope, for example. The imaging device 124 canbe configured to detect the presence of smoke S in a visual field at thesurgical site. In another aspect, the on/off control for the pump 12446is controlled based on inputs from a smoke sensor 12453 (FIG. 217 )in-line with the fluid being pumped out of the patient. For example, thepump 12446 can remain on as long as a threshold amount of smoke S isdetected by the smoke sensor 12453 and can be turned off or paused whenthe detected volume of smoke S falls below the threshold amount. Instill another aspect, the pump 12446 is turned on when energy isactivated and, in certain instances, can remain on for a period of timeafter the energy has been stopped. The duration of time for which thepump 12446 can remain on after the energy has stopped may be fixed ormay be proportional to the length of time the energy was activated, forexample.

Referring primarily to FIG. 220 , a flow chart depicting logic steps foroperating a pump, such as the pump 12446, is depicted. A processor forthe robot (e.g. robot 12022) and/or a processor of a hub (e.g. hub 106,hub 206, robotic hub 122, and robotic hub 222) that is in signalcommunication with the robot can determine or estimate the rate of smokeevacuation from the surgical site. The rate of smoke evacuation can bedetermined at step 12510 by one or more factors or inputs including theactivation of energy by the robotic tool (a first input 12502), a smokesensor in-line with the smoke evacuation channel (a second input 12504),and/or an imaging device configured to view the surgical site (a thirdinput 12506). The first input 12502 can correspond to the duration ofenergy application and/or the power level, for example. Based on the oneor more factors, the pump can be adjusted at step 12512. For example,the rate at which the rotary driver drives the pump can be adjusted. Inother instances, the rotary driver can stop or pause the operation ofthe pump while the detected rate of smoke evacuation is below athreshold volume. The flow chart of FIG. 220 can continue throughout theoperation of a robotic tool. In certain instances, the steps 12510 and12512 can be repeated at predefined intervals during a surgicalprocedure and/or when requested by a clinician and/or recommend by ahub.

Referring now to FIG. 219 , a robotic tool 12526 for use with a roboticsurgical system is depicted. The robotic tool 12526 can be employed withthe robotic surgical system 12010 (FIG. 206 ), for example. The robotictool 12526 is an ultrasonic robotic tool having cooling and insufflationcapabilities. For example, the robotic tool 12526 can be similar in manyrespects to the robotic tool disclosed in U.S. Pat. No. 9,314,308, filedMar. 13, 2013, entitled ROBOTIC ULTRASONIC SURGICAL DEVICE WITHARTICULATING END EFFECTOR, which is herein incorporated by reference inits entirety.

The robotic tool 12526 includes a proximal housing 12537, a shaft 12538extending from the proximal housing 12537, and an end effector 12528extending from a distal end of the shaft 12538. The end effector 12528includes an ultrasonic blade 12530 a and an opposing clamp arm 12530 b.The robotic tool 12526 also includes an irrigation system 12536, whichis configured to provide a coolant, such as saline or cool CO₂ forexample, to the surgical site. Irrigation can be configured to cool thetissue and/or the ultrasonic blade 12530 a, for example. The irrigationsystem 12536 includes an irrigation channel 12540, which extends throughthe shaft 12538 to the proximal housing 12537. The irrigation channel12540 terminates at an irrigation port adjacent to the end effector12528.

In various instances, the irrigation channel 12540 can be coupled to ablower configured to direct fluid along the irrigation channel 12540within the shaft 12538 of the robotic tool 12526. The irrigation system12536 includes a blower 12546. The blower 12546 is housed in theproximal housing 12537 of the robotic tool 12526. The blower 12546 is aregenerative blower, which has been incorporated into a drive interface12548 of the robotic tool 12526. The drive interface 12548 includesrotary drivers 12550, which are driven by rotary outputs from motors inthe tool mounting portion of the robot, as described herein (see rotaryoutputs 12256 (FIG. 214 ) and rotary outputs 12824 a-12824 e (FIG. 222), for example).

A channel 12552 terminating in a fitting 12554 extends from the blower12546. The fitting 12554 is a luer fitting, however, the reader willreadily appreciate that alternative fittings are envisioned. The luerfitting can be selectively coupled to a reservoir that is configured toprovide the irrigation fluid to the blower 12546. In operation, coolantcan enter the insufflation line through the fitting 12554 and the blower12546 can draw the coolant toward the blower 12546 at the driveinterface 12548 and then blow the coolant distally along the shaft 12538of the robotic tool 12526 toward the end effector 12528. The coolant canbe expelled at or adjacent to the end effector 12528, which can cool theultrasonic blade and/or maintain insufflation of the surgical site, suchas insufflation of an abdomen, for example.

In FIG. 219 , internal components of the drive interface 12548 aredepicted, however, certain components are excluded for clarity. Theirrigation channel 12540 extends through the shaft 12538 to the blower12546 in the proximal housing 12537. The blower 12546 is driven by arotary driver 12550 of the drive interface 12548. Similar to theinterface 12448 (FIG. 218 ), the interface 12548 includes four rotarydrivers 12550. In one example, a first rotary driver 12550 is configuredto power an articulation motion, a second rotary driver 12550 isconfigured to power a jaw closure motion, a third rotary driver 12550 isconfigured to power a shaft rotation, and a fourth rotary driver 12550is configured to power the irrigation system 12536. The reader willappreciate that alternative interface arrangements can include more thanor less than four rotary drivers 12550. Additionally, the drive motionsgenerated by the rotary drivers 12550 can vary depending on the desiredfunctionality of the robotic tool. Moreover, in certain instances, thedrive interface 12548 can include a transmission or shifter such thatthe rotary drivers 12550 can shift between multiple surgical functions,as further described herein (see transmission 12124 in FIG. 212 andtransmission assembly 12840 in FIGS. 223-228 , for example). In oneinstance, the rotary driver 12550 coupled to the blower 12546 can alsoactuate a clamping motion of the end effector 12528, for example.

As described herein with respect to the pump 12446 in FIG. 218 ,operation of the blower 12546 in FIG. 219 can be coordinated with theapplication of energy by the robotic tool 12526. For example, the blower12546 can be turned on when energy is activated and, in certaininstances, the blower 12546 can remain on for a period of time after theenergy has been stopped. The duration of time for which the blower 12546can remain on after the energy has stopped may be fixed or may beproportional to the length of time the energy was activated, forexample. Additionally or alternatively, the power level of the blower12546 can be proportional or otherwise related to the activation levelof the robotic tool 12526. For example, a high power level cancorrespond to a first rate and a lower power level can correspond to asecond rate. In one example, the second rate can be less than the firstrate.

In one aspect, the robotic tool 12526 can also include an insufflationpump that is upstream of the regenerative blower 12546. The insufflationpump can direct a first volume of fluid into a trocar and a secondvolume of fluid into the regenerative blower 12546. The fluid providedto the trocar can be configured to insufflate the surgical site, forexample, the abdomen of a patient. The fluid provided by theregenerative blower 12546 can be configured to cool the ultrasonicblade, for example.

The robotic surgical tools 12426 and 12526 can be used in connectionwith a hub, such as the robotic hub 122 or the robotic hub 222, forexample. In one aspect, the robotic hubs can include a situationalawareness module, as described herein. The situational awareness modulecan be configured to determine and/or confirm a step in a surgicalprocedure and/or suggest a particular surgical action based oninformation received from various sources, including one or more roboticsurgical tool(s) and/or a generator module. In one instance, theactuation of a pump on a robotic surgical tool can inform thesituational awareness module that evacuation and/or irrigation have beenemployed, which can lead to a conclusion regarding a particular surgicalprocedure or group of surgical procedures. Similarly, data from thesituational awareness module can be supplied to a processor. In certaininstances, the processor can be communicatively coupled to a memory thatstores instructions executable by the processor to adjust a pumping rateof the pump based on data from the situational awareness module whichcan indicate, for example, the type of surgical procedure and/or thestep in the surgical procedure. For example, situational awareness canindicate that insufflation is necessary for at least a portion of aparticular surgical procedure. In such instances, a pump, such as theblower 12546 (FIG. 219 ) can be activated and/or maintained at a levelto maintain a sufficient insufflation.

In one aspect, the robotic surgical system includes a processor and amemory communicatively coupled to the processor, as described herein.The memory stores instructions executable by the processor to rotate adriver in a robotic tool at a variable rate to provide an adjustablepower level to a pump in the robotic tool, as described herein.

In various aspects, the present disclosure provides a control circuit torotate a rotary driver in a robotic tool at a variable rate, asdescribed herein. In various aspects, the present disclosure provides anon-transitory computer readable medium storing computer readableinstructions which, when executed, cause a machine to rotate a rotarydriver in a robotic tool at a variable rate to provide an adjustablepower level to a pump in the robotic tool, as described herein.

Referring now to FIGS. 234 and 235 , a surgical procedure utilizing tworobotic tools is depicted. In FIG. 234 , the robotic tools are engagedwith tissue at a surgical site. The first tool in this example is aflexible robotic retractor 12902, which is applying a retracting forceto a portion of a patient's liver L. In FIG. 235 , the flexible roboticretractor 12902 can be moved along a longitudinal axis of the tool shaftin a direction A and/or can be moved laterally (e.g. pivoted at a jointbetween two rigid linkages in the robotic retractor) in a direction B.

The second tool in this example is an articulating bipolar tool 12904,which is being clamped on tissue. For example, the articulating bipolartool 12904 can be configured to mobilize liver attachments A to theliver utilizing bipolar RF currents. The articulating bipolar tool 12904can be articulated laterally (e.g. pivoted at an articulation jointproximal to the bipolar jaws of the robotic tool 12904) in the directionC. The directions A, B, and C are indicated with arrows in FIG. 235 .

In the depicted example, the flexible robotic retractor 12902 seeks tohold back an organ, the liver L, as the bipolar jaws of the articulatingbipolar tool 12904 seek to cut and/or seal clamped tissue to mobilizethe liver attachments A. In one aspect, movement of the liver L by theflexible robotic retractor 12902 can be configured to maintain aconstant retraction force as the bipolar tool 12904 mobilizes the liverattachments A to the liver L. A load control algorithm can be configuredto maintain the constant retraction force on the tissue. In certaininstances, the load control algorithm can be an articulation controlalgorithm that provides a set, or predetermined, torque at thearticulation joint(s) of the articulating bipolar tool 12904 and/or theflexible robotic retractor 12902. The set torque at an articulationjoint can be approximated based on current supplied to the articulationmotor, for example.

In certain instances, the flexible robotic retractor 12902 can risk orotherwise threaten over-retraction of the liver L. For example, ifdisplacement of the flexible robotic retractor 12902 approaches a setdisplacement limit, the flexible robot retractor 12902 can risk tearinga portion of the tissue. To prevent such an over-retraction, as thedisplacement of the flexible robotic retractor 12902 approaches thedisplacement limit, the force generated by the flexible roboticretractor 12902 can be reduced by the load control algorithm. Forexample, the force can be reduced below a constant, or substantiallyconstant, retraction force when a displacement limit has been met.

Referring now to a graphical display 12910 in FIG. 236 , the retractionforce F exerted on an organ and the displacement δ of the robotic tool,and by extension the organ, is plotted over time. The reader willappreciate that the robotic tools 12902 and 12904, as depicted in thesurgical procedure of FIGS. 234 and 235 , can be utilized to generatethe graphical display 12910. Alternative surgical tool(s) and surgicalprocedures are also contemplated. In one aspect, an operator can set aretraction force threshold Y and a displacement limit X as depicted inFIG. 236 . In other instances, the retraction force threshold Y and/orthe displacement limit X can be determined and/or computed based oninformation from a surgical hub and/or cloud. In certain instances, aparticular retraction force threshold Y and/or displacement limit X canbe recommended to a clinician based on data stored in the memory of therobot, the surgical hub, and/or the cloud. The retraction forcethreshold Y and/or the displacement limit X can depend on patientinformation, for example.

During the surgical procedure, if the retraction force F drops below theconstant retraction force threshold Y, or drops by a predefinedpercentage or amount relative to the constant retraction force thresholdY, as at times t₁, t₂, and t₃, the flexible robotic retractor 12902 canbe further displaced, to displace the organ, and increase the retractionforce F toward the threshold Y. Similarly, if the displacement δapproaches the displacement limit X, as at time t₄, the retraction forcecan be reduced to limit further displacement beyond the displacementlimit X. For example, referring again to FIG. 234 , the liver L isdepicted in a second position indicated as L′. The position of the liverL′ can correspond to the displacement limit X of the flexible roboticretractor 12902.

Referring now to FIG. 237 , a flow chart depicting logic steps foroperating a robotic tool, such as the tool 12902 (FIGS. 234 and 235 )for example, is depicted. A processor for the robot (e.g. the robot12022) and/or of a processor of a hub (e.g. the hub 106, the hub 206,the robotic hub 122, and the robotic hub 222) that is in signalcommunication with the robot can set a displacement limit at step 12920.Additionally, the processor can set a force limit at step 12922. Thedisplacement limit and the force limit can be selected based on inputfrom one or more sources including a clinician input 12930, a robotinput 12932, a hub input 12934, and/or a cloud input 12936, as furtherdescribed herein. In certain instances, the hub can suggest a particularlimit based on data collected by a robot, provided to the hub, and/orstored in the cloud. For example, a situational awareness module cansuggest a particular limit based on the surgical procedure or stepthereof ascertained by the situational awareness module. Additionally oralternatively, the clinician can provide an input and/or select thelimit from the hub's suggestions. In other instances, the clinician canoverride the hub's suggestions. The limits can correspond to a range ofvalues, such as the limit±one percent, ±five percent, or ±ten percent,for example.

The robotic tool can initially operate in a constant force mode. At step12924 in the constant force mode, the force exerted by the robotic toolcan be maintained at the force limit. The processor can monitor theforce to ensure the force stays below the force limit Y. If the forceexceeds the force limit Y, the displacement value can be increased atstep 12926 until the force reaches or sufficiently approaches the forcelimit Y. A force can sufficiently approach the force limit when theforce is within a range of values corresponding to the force limit. Theprocessor can monitor the displacement to ensure the displacement staysbelow the displacement limit X.

If the displacement approaches the displacement limit X (or enters therange of values corresponding to the displacement limit), the robotictool can switch to a displacement limit mode. In the displacement limitmode, the force value can be decreased at step 12928 to ensure therobotic tool stays within the displacement limit. A new force limit canbe set at step 12922 to ensure the displacement stays within thedisplacement limit. In such instances, the robotic tool can switch backto the constant force mode (with the new, reduced force limit) and steps12924, 12926, and 12928 can be repeated.

In certain instances, the stiffness of the shaft of one or more of therobotic tools can be factored into the load control algorithm in orderto achieve the desired amount of lateral force on an organ, like theliver L. For example, the flexible robotic retractor 12902 can define astiffness that affects the lateral load exerted on a tissue by the endeffector thereof.

In certain instances, a drive housing for a robotic tool can include aplurality of rotary drivers, which can be operably driven by one or moremotors. The motors can be positioned in a motor carriage, which can belocated at the distal end of a robotic arm. In other instances, themotors can be incorporated into the robotic tool. In certain instances,a motor can operably drive multiple rotary drivers and a transmissioncan be configured to switch between the multiple rotary drivers. In suchinstances, the robotic tool cannot simultaneously actuate two or morerotary drivers that are associated with the single drive motor. Forexample, as described herein with respect to FIG. 212 , the motor 12112can selectively power one of the roll DOF 12132, the high force grip DOF12136, or the tool actuation DOF 12138. The transmission 12124 canselectively couple the motor 12112 to the appropriate DOF.

In certain instances, it can be desirable to increase the torquedelivered to an output of the robotic tool. For example, clamping and/orfiring of a surgical stapler may benefit from additional torque incertain instances, such as when the tissue to be cut and/or stapled isparticularly thick or tough. Especially for longer end effectors and/orlonger firing strokes, additional torque can be required to complete thefiring stroke. In certain instances, an I-beam firing structure can beutilized, especially for longer end effectors and/or longer firingstrokes. The I-beam can limit deflection at the distal tip of the firingstroke for example. However, an I-beam can require increased torque.

Additionally, certain robotic tools may require additional flexibilityregarding the simultaneous operation of multiple DOFs or surgical endeffector functions. To increase the power, torque, and flexibility of arobotic system, additional motors and/or larger motors can beincorporated into the motor carriage. However, the addition of motorsand/or utilization of larger motors can increase the size of the motorcarriage and the drive housing.

In certain instances, a robotic surgical tool can include a compactdrive housing. A compact drive housing can improve the access envelopeof the robotic arm. Moreover, a compact drive housing can minimize therisk of arm collisions and entanglements. Though the drive housing iscompact, it can still provide sufficient power, torque, and flexibilityto the robotic tool.

In certain instances, shifting between end effector functions can beachieved with one of the drive shafts. Shifting and locking of therotary drives may only occur when a robotic surgical system is in a restmode, for example. In one aspect, it can be practical to have threerotary drives operate as many end effector functions as needed based onthe cam structure of the shifting drive. In one aspect, by using threerotary drives in cooperation, a robotic surgical tool can shift betweenfour different possible functions instead of three different functions.For example, three rotary drives can affect shaft rotation, independenthead rotation, firing, closing, and a secondary closing means. In stillother instances, a rotary drive can selectively power a pump, such as inthe surgical tools 12426 and 12526 in FIGS. 218 and 219 , respectively,for example.

Additionally or alternatively, multiple rotary drives can cooperativelydrive a single output shaft in certain instances. For example, toincrease the torque delivered to a surgical tool, multiple motors can beconfigured to deliver torque to the same output shaft at a given time.For example, in certain instances, two drive motors can drive a singleoutput. A shifter drive can be configured to independently engage anddisengage the two drive motors from the single output. In suchinstances, increased torque can be delivered to the output by a compactdrive housing that is associated with multiple rotary drivers and endeffector functions. As a result, load capabilities of the surgical toolcan be increased. Moreover, the drive housing can accommodate surgicaltools that require different surgical functions, including the operationof multiple DOFs or surgical functions.

Referring now to FIGS. 221-228 , a drive system 12800 for a roboticsurgical tool 12830 is depicted. The drive system 12800 includes ahousing 12832 and a motor carriage 12828. A shaft 12834 of the surgicaltool 12830 extends from the housing 12832. The motor carriage 12828houses five motors 12826 similar to the motor carriage 12108 (FIG. 212). In other instances, the motor carriage 12828 can house less than fivemotors or more than five motors. In other instances, the motors 12826can be housed in the robotic surgical tool 12830.

Each motor 12826 is coupled to a rotary output 12824 and each rotaryoutput 12824 is coupled to a rotary input 12836 in the housing 12832 ata drive interface 12822. The rotary motions from the motors 12826 andcorresponding rotary outputs 12824 are transferred to a respectiverotary input 12836. The rotary inputs 12836 correspond to rotarydrivers, or rotary drive shafts, in the housing 12832. In one example, afirst motor 12826 a can be a left/right articulation (or yaw) motor, asecond motor 12826 b can be an up/down articulation (or pitch) motor, athird motor 12826 c can be a shifter motor, a fourth motor 12826 d canbe a first cooperative motor, and a fifth motor 12826 e can be a secondcooperative motor. Similarly, a first rotary output 12824 a can be aleft/right articulation (or yaw) output, a second rotary output 12824 bcan be an up/down articulation (or pitch) output, a third rotary output12824 c can be a shifter output, a fourth rotary output 12824 d can be afirst cooperative output, and a fifth rotary output 12824 e can be asecond cooperative output. Furthermore, a first rotary input 12836 a canbe a left/right articulation (or yaw) drive shaft, a second rotary input12836 b can be an up/down articulation (or pitch) drive shaft, a thirdrotary input 12836 c can be a shifter drive shaft, a fourth rotary input12836 d can be a first cooperative drive shaft, and a fifth rotary input12836 e can be a second cooperative drive shaft. In other instances, thedrive shafts 12836 a-12836 e can be operably positionable in differentorientations to effectuate different gear trains configurations totransmit a desired rotary output.

The surgical tool 12830 is depicted in a plurality of differentconfigurations in FIGS. 230-233 . For example, the surgical tool 12830is in an unactuated configuration in FIG. 230 . The shaft 12834 has beenarticulated about the yaw and pitch axes (in the directions of thearrows A and B) in FIG. 231 . Rotation of the first and second rotaryinputs 12836 a and 12836 b is configured to articulate the shaft 12834about the yaw and pitch axes, respectively. In FIG. 232 , the shaft12834 has been rotated in the direction of the arrow C about thelongitudinal axis of the shaft 12834 and a jaw of the end effector 12835has been closed with a low-force actuation in the direction of arrow D.Rotation of the fourth rotary output 12836 d is configured toselectively affect the rotation of the shaft 12834, and rotation of thefifth rotary output 12836 e is configured to selectively affect thelow-force closure of the end effector 12835. In FIG. 233 , the jaw ofthe end effector 12835 has been clamped with a high-force actuation inthe direction of arrow E, and the firing member has been advanced in thedirection of arrow F. Rotation of the fourth rotary output 12836 d andthe fifth rotary output 12836 e is configured to selectively andcooperatively affect the high-force closure of the end effector 12835and the firing of the firing member therein, respectively.

Referring primarily now to FIGS. 223-228 , the housing 12832 includesmultiple layers of gear train assemblies. Specifically, the housing12832 includes a first gear train assembly 12838 a layered under asecond gear train assembly 12838 b, which is layered under a third geartrain assembly 12838 c, which is layered under a fourth gear trainassembly 12838 d. The first gear train assembly 12838 a corresponds to afirst DOF, such as rotation of the shaft 12834, for example. The secondgear train assembly 12838 b corresponds to a second DOF, such as closure(i.e. fast closure) of the end effector 12835 with a low closure force,for example. The third gear train assembly 12838 c corresponds to athird DOF, such as clamping (i.e. slow closure) of the end effector12835 with a high closure force, for example. The fourth gear trainassembly 12838 d corresponds to a fourth DOF, such as firing of a firingelement in the end effector 12835, for example. The five rotary inputs12836 a-12836 e extend through the four layers of gear train assemblies12838 a-12838 d.

The first motor 12826 a is drivingly coupled to the first rotary input12836 a. In such instances, the first motor 12826 a is singularlyconfigured to drive the first rotary input 12836 a, which affects thefirst DOF. For example, referring primarily to FIG. 224 , articulationwires 12842 can extend from the first rotary input 12836 a through theshaft 12834 of the robotic tool 12830 toward the end effector 12835.Rotation of the first rotary input 12836 a is configured to actuate thearticulation wires 12842 to affect left/right articulation of the endeffector 12835. Similarly, the second motor 12826 b is drivingly coupledto the second rotary input 12836 b. In such instances, the second motor12826 b is singularly configured to drive the second rotary input 12836b, which affects the second DOF. Referring still to FIG. 224 ,articulation wires 12844 can extend from the second rotary input 12836 bthrough the shaft 12834 of the robotic tool 12830 toward the endeffector 12835. Rotation of the second rotary input 12836 b isconfigured to actuate the articulation wires 12844 to affect up/downarticulation of the end effector 12835. In other instances, at least oneof the first rotary input 12836 a and the second rotary input 12836 bcan correspond to a different DOF or different surgical function.

The housing 12832 also includes a transmission assembly 12840. Forexample, the third rotary input 12836 c is a shifter drive shaft of thetransmission assembly 12840. As depicted in FIGS. 223-228 , the thirdrotary input 12836 c can be a camshaft, including a plurality of camminglobes. An arrangement of cam lobes 12839 can correspond with each geartrain assembly 12838 a-12838 d layered in the housing 12832. Moreover,each gear train assembly 12838 a-12838 d includes a respective shuttle12846 a-12846 d operably engaged by the third rotary input 12836 c. Forexample, the third rotary input 12836 c can extend through an opening ineach shuttle 12846 a-12846 d and selectively engage at least oneprotrusion 12848 on the shuttle 12846 a-12846 d to affect shifting ofthe respective shuttle 12846 a-12846 d relative to the third rotaryinput 12836 c. In other words, rotation of the third rotary input 12836c is configured to affect shifting of the shuttles 12846 a-12846 d. Asthe shuttles 12846 a-12846 d shift within each gear train assembly 12838a-12838 d, respectively, the cooperative drive shafts 12836 d and 12836e are selectively drivingly coupled to one or more output shafts of therobotic tool 12830, as further described herein.

In other instances, a drive system for a robotic tool can include avertically shifting gear selector, which can be configured to shift theshuttles 12846 a-12846 d or otherwise engage an output drive from amotor to one or more input drives on the robotic tool 12830.

Referring still to FIGS. 221-228 , the fourth and fifth output drives,or the first and second cooperative drive shafts, 12836 d and 12836 e,respectively, can operate independently or in a coordinated,synchronized manner. For example, in certain instances, each cooperativedrive shaft 12836 d and 12836 e can be paired with a single output gearor output shaft. In other instances, both cooperative drives 12836 d and12836 e can be paired with a single output gear or output shaft.

Referring primarily to FIG. 225 , in a first configuration of thetransmission arrangement 12840, the first cooperative drive shaft 12836d is drivingly engaged with a first output gear 12852 of the first geartrain assembly 12838 a. For example, the first gear train assembly 12838a includes one or more first idler gears 12850 a. In FIG. 225 , thefirst gear train assembly 12838 a includes two first idler gears 12850a. The first idler gears 12850 a are positioned on the first shuttle12846 a in the first gear train assembly 12838 a. In the firstconfiguration (FIG. 225 ), the first shuttle 12846 a has been shiftedtoward the first output gear 12852 by the camshaft 12836 c such that oneof the first idler gears 12850 a on the first shuttle 12846 a is movedinto meshing engagement with the first output gear 12852 and one of thefirst idler gears 12850 a is moved into meshing engagement with thefirst cooperative drive shaft 12836 d. In other words, the firstcooperative drive shaft 12836 d is drivingly engaged with the firstoutput gear 12852.

Rotation of the first output gear 12852 corresponds to a particular DOF.For example, rotation of the first output gear 12852 is configured torotate the shaft 12834 of the robotic tool 12830. In other words, in thefirst configuration of the transmission arrangement 12840 (FIG. 225 ), arotation of the fourth motor 12826 d and the fourth rotary output 12824d is configured to rotate the first cooperative drive shaft 12836 d,which is coupled to the first output gear 12852 via the first idlersgears 12850 a and rotates (or rolls) the shaft 12834.

The first gear train assembly 12838 a also includes a first locking arm12860 a. The first locking arm 12860 a extends from the first shuttle12846 a. Movement of the first shuttle 12846 a is configured to move thefirst locking arm 12860 a. For example, in the first configuration ofFIG. 225 , the first locking arm 12860 a is disengaged from the firstgear train assembly 12838 a such that the first output gear 12852 canrotate. Movement of the first shuttle 12846 a can move the first lockingarm 12860 a into engagement with the first output gear 12852. Forexample, when the first idler gears 12850 a are moved out of engagementwith the first output gear 12852, the first locking arm 12860 a canengage the first output gear 12852 or another gear in the first geartrain assembly 12838 a to prevent the rotation of the first output gear12852.

Referring still to FIG. 225 , in the first configuration of thetransmission arrangement 12840, the second cooperative drive shaft 12836e is drivingly engaged with a second output gear 12854 of the secondgear train assembly 12838 b. For example, the second gear train assembly12838 b includes one or more second idler gears 12850 b and a planetarygear 12853 that is meshingly engaged with the second output gear 12854.In FIG. 225 , the second gear train assembly 12838 b includes two secondidler gears 12850 b. The second idler gears 12850 b are positioned onthe second shuttle 12846 b in the second gear train assembly 12838 b. Inthe first configuration, the second shuttle 12846 b has been shiftedtoward the second output gear 12854 by the camshaft 12836 c such thatone of the second idler gears 12850 b on the second shuttle 12846 b ismoved into meshing engagement with the planetary gear 12853, and one ofthe second idler gears 12850 b is moved into meshing engagement with thesecond cooperative drive shaft 12836 e. In other words, the secondcooperative drive shaft 12836 e is drivingly engaged with the secondoutput gear 12854 via the second idler gears 12850 b and the planetarygear 12853. The second output gear 12854 is configured to drive a secondoutput shaft 12864 (FIGS. 226-228 ), which transfers a drive motion tothe end effector 12835.

Rotation of the second output gear 12854 corresponds to a particularDOF. For example, a rotation of the second output gear 12854 isconfigured to close the end effector 12835 of the robotic tool 12830with a low closure force. In other words, in the first configuration ofthe transmission arrangement 12840, a rotation of the fifth motor 12826e and the fifth rotary output 12824 e is configured to rotate the secondcooperative drive shaft 12836 e, which is coupled to the second outputgear 12854, via the second idlers gears 12850 b and the planetary gear12853, and closes the end effector 12835 of the robotic tool 12830 witha low closure force.

The second gear train assembly 12838 b also includes a second lockingarm 12860 b. The second locking arm 12860 b extends from the secondshuttle 12846 b. Movement of the second shuttle 12846 b is configured tomove the second locking arm 12860 b. For example, in the firstconfiguration of FIG. 225 , the second locking arm 12860 b is disengagedfrom the planetary gear 12853. Movement of the second shuttle 12846 bcan move the second locking arm 12860 b into engagement with the secondplanetary gear 12853. For example, when the second idler gears 12850 bare moved out of engagement with the second gear train assembly 12838 bor planetary gear 12853 thereof, the second locking arm 12860 b canengage a portion of the second gear train assembly 12838 b, such asplanetary gear 12853, for example, to prevent rotation of the planetarygear 12853 and the second output gear 12854.

In the first configuration, rotary drive motions can be concurrentlyapplied to the first and second cooperative drive shafts 12836 d and12836 e, respectively, to concurrently affect multiple degrees offreedom. For example, the transmission arrangement 12840 can permit thesimultaneous rotation of the shaft 12834 and closing of the end effectorjaws. In other instances, one of the output gears 12852, 12854 can belocked by the respective locking arm when the other output gear 12852,12854 is drivingly coupled to the respective cooperative drive shaft12836 d, 12836 e.

Referring still to FIG. 225 , in the first configuration of thetransmission arrangement 12840, a third output gear 12856 in the thirdgear train assembly 12838 c and a fourth output gear 12858 in the fourthgear train assembly 12838 d are locked via the locking arms 12860 c and12860 d, respectively. As a result, rotation of the third output gear12856, which corresponds to clamping or high-force closing of the endeffector jaws, is prevented by the first configuration. Additionally,rotation of the fourth output gear 12858, which corresponds to firingthe firing member in the end effector 12835, is also prevented. In otherwords, when the transmission arrangement 12840 is configured to deliverrotary motions to affect a low-force closure DOF or shaft rotation DOF,high-force clamping and firing is prevented. In such instances, thehigh-force clamping function and firing function can be selectivelylocked out by the transmission arrangement 12840.

Referring now to FIG. 226 , a second configuration of the transmissionarrangement 12840 is depicted. In the second configuration, the firstand second cooperative drive shafts 12836 d and 12836 e are drivinglyengaged with a third output gear 12856 of the third gear train assembly12838 c. The third output gear 12856 is configured to drive a thirdoutput shaft 12866 (FIGS. 226-228 ), which transfers a drive motion tothe end effector 12835. For example, the third gear train assembly 12838c includes one or more third idler gears 12850 c and a planetary gear12855 that is meshingly engaged with the third output gear 12856. InFIG. 226 , the third gear train assembly 12838 c includes three thirdidler gears 12850 c. The third idler gears 12850 c are positioned on thethird shuttle 12846 c in the third gear train assembly 12838 c. In thesecond configuration, the third shuttle 12846 c has been shifted towardthe third output gear 12856 by the camshaft 12836 c such that one of thethird idler gears 12850 c is moved into meshing engagement with theplanetary gear 12855, one of the third idler gears 12850 c is moved intomeshing engagement with the first cooperative drive shaft 12836 d, andone of the third idler gears 12850 c is moved into meshing engagementwith the second cooperative drive shaft 12836 e. In other words, bothcooperative drive shafts 12836 d and 12836 e are drivingly engaged withthe third output gear 12856 via the third idler gears 12850 c and theplanetary gear 12855.

Rotation of the third output gear 12856 corresponds to a particular DOF.For example, a rotation of the third output gear 12856 is configured toclamp the end effector 12835 of the robotic tool 12830 with a highclosure force. In other words, in the second configuration of thetransmission arrangement 12840, a rotation of the fourth motor 12826 dand the fifth motor 12826 e and the corresponding rotation of the fourthrotary output 12824 d and the fifth rotary output 12824 e are configuredto rotate the cooperative drive shafts 12836 d and 12836 e,respectively. In such instances, a torque supplied by both cooperativedrive shafts 12836 d and 12836 e is coupled to the third output gear12856 via the third idlers gears 12850 c to clamp the end effector 12835of the robotic tool 12830 with a high closure force.

Referring still to FIG. 226 , in the second configuration of thetransmission arrangement 12840, the third output gear 12856 is unlocked.More specifically, the third locking arm 12860 c is disengaged from thethird gear train assembly 12838 c such that the third output gear 12856can rotate. Additionally, the camshaft 12836 c has moved the firstlocking arm 12860 a into engagement with the first gear train assembly12838 a, the second locking arm 12860 b into engagement with the secondgear train assembly 12838 b, and the fourth locking arm 12860 d intoengagement with the fourth gear train assembly 12838 d to preventrotation of the first output gear 12852, the second output gear 12854,and the fourth output gear 12858, respectively. As a result, rotation ofthe shaft 12834, low-force closing of the end effector jaws, and firingof the end effector 12835, is prevented by the transmission arrangement12840 in the second configuration. In such instances, the shaft rotationfunction, the low-force closing function, and the firing function can beselectively locked out by the transmission arrangement 12840.

Referring now to FIG. 227 , a third configuration of the transmissionarrangement 12840 is depicted. In the third configuration, the first andsecond cooperative drive shafts 12836 d and 12836 e are drivinglyengaged with a fourth output gear 12858 of the fourth gear trainassembly 12838 d. For example, the fourth gear train assembly 12838 dincludes one or more fourth idler gears 12850 d and a planetary gear12857 that is meshingly engaged with the fourth output gear 12858. InFIG. 227 , the fourth gear train assembly 12838 d includes three fourthidler gears 12850 d. The fourth idler gears 12850 d are positioned onthe fourth shuttle 12846 d in the fourth gear train assembly 12838 d. Inthe third configuration, the fourth shuttle 12846 d has been shiftedtoward the fourth output gear 12858 by the camshaft 12836 c such thatone of the fourth idler gears 12850 d is moved into meshing engagementwith the planetary gear 12857, one of the fourth idler gears 12850 d ismoved into meshing engagement with the first cooperative drive shaft12836 d, and one of the fourth idler gears 12850 d is moved into meshingengagement with the second cooperative drive shaft 12836 e. In otherwords, both cooperative drive shafts 12836 eand 12836 e are drivinglyengaged with the fourth output gear 12858 via the fourth idler gears12850 d and the planetary gear 12857. The fourth output gear 12858 isconfigured to drive a third output shaft 12868 (FIGS. 226-228 ), whichtransfers a drive motion to the end effector 12835.

Rotation of the fourth output gear 12858 corresponds to a particularDOF. For example, a rotation of the fourth output gear 12858 isconfigured to firing a firing member in the end effector 12835 of therobotic tool 12830. In other words, in the third configuration of thetransmission arrangement 12840, a rotation of the fourth motor 12826 dand the fifth motor 12826 e and the corresponding rotation of the fourthrotary output 12824 d and the fifth rotary output 12824 e are configuredto rotate the cooperative drive shafts 12836 d and 12836 e,respectively. In such instances, a torque supplied by both cooperativedrive shafts 12836 d and 12836 e is coupled to the fourth output gear12858 via the fourth idlers gears 12850 d and planetary gear 12857 tofire the end effector 12835 of the robotic tool 12830.

Referring still to FIG. 227 , in the third configuration of thetransmission arrangement 12840, the fourth output gear 12858 isunlocked. More specifically, the fourth locking arm 12860 d isdisengaged from the fourth gear train assembly 12838 d such that thefourth output gear 12858 can rotate. Additionally, the camshaft 12836 chas moved the first locking arm 12860 a into engagement with the firstgear train assembly 12838 a, the second locking arm 12860 b intoengagement with the second gear train assembly 12838 b, and the thirdlocking arm 12860 c into engagement with the third gear train assembly12838 c to prevent rotation of the first output gear 12852, the secondoutput gear 12854, and the third output gear 12856, respectively. As aresult, rotation of the shaft 12852, low-force closing of the endeffector jaws, and high-force clamping of the end effector jaws isprevented by the transmission arrangement 12840 in the thirdconfiguration. In such instances, the shaft rotation function, thelow-force closing function, and the high-force clamping function can beselectively locked out by the transmission arrangement 12840.

In one aspect, the dual drive motors 12826 d and 12826 e can coordinatewith the shifting motor 12826 c to provide a compact drive housing 12832that enables multiple end effector functions. Moreover, a greater torquecan be supplied for one or more end effector functions via thecooperative drive shafts 12836 d and 12836 e.

In one aspect, when the cooperative drive shafts 12836 d and 12836 e areoperated together, the two drives shafts 12836 d and 12836 e aresynchronized. For example, the drive shafts 12836 d and 12836 e can bothdrive a common output shaft such as the output shafts 12866 and/or12868. Torque can be provided to the common output shafts 12866 and/or12868 via both drive shafts 12836 d and 12836 e.

Referring now to FIG. 229 , a graphical display 12890 of output torquefor different surgical functions of a robotic tool, such as the robotictool 12830 (FIGS. 221-228 ), for example, is depicted. The output torquefor rotating the tool shaft (e.g. shaft 12834) via a first cooperativedrive shaft and for low-force closing of end effector jaws via a secondcooperative drive shaft are less than t1, the maximum output torque froma single shaft. The lower output torques for shaft rotation andlow-force jaw closure can be within the range of loads obtainable from acable on a spindle, for example. In certain instances, other lower loadfunctionalities of the surgical tool can be affected with the outputfrom a single shaft.

To affect high-force clamping, the torque approaches t2, the maximumoutput torque from the cooperative drive shafts (e.g. cooperative driveshafts 12836 d and 12836 e). For example, t2 can be twice the value oft1. The values “a” and “b” in FIG. 229 show relative forces for therobotic tool. The value “a” is the load difference between a low-forceclosure and high-force clamping, such as closure with a closure tubesystem and clamping via an I-beam, example. In certain instances, aclosure tube system and an I-beam system can cooperate, or overlaptemporally as shown in FIG. 229 , to complete the clamping of the endeffector. The value “b” can be equal to or less than the value “a”. Forexample, the torque required to fire the end effector can be the same,or substantially the same, as the difference in torque between low-forceclosing and high-force clamping. The values “a” and “b” are more thanthe maximum output torque from a single shaft, but less than the maximumoutput torque from cooperative drive shafts.

In one instance, the synchronization of multiple drive shafts (e.g.cooperative drive shafts 12836 d and 12836 e) can be the slaving of onedrive shaft to the following of the other drive shaft. For example, adifferent maximum torque threshold can be set on the slaved drive shaftsuch that it can push up to the first drive shaft's limit but not overit. In one aspect, the speed of the output shaft can be monitored forincreases and/or decreases in rotational speed. For example, a sensorcan be positioned to detect the rotational speed of the output shaft.Further, the cooperative drive shafts can be coordinated to balance thetorque when one of the cooperative drive shafts begins to slow down orbrake the output shaft instead of both cooperative drive shaftsaccelerating it.

The motors described herein are housed in a tool mount on a robotic arm.In other instances, one or more of the motors can be housed in therobotic tool.

In one aspect, input drivers at an interface of the robotic tool areconfigured to mechanically and electrically couple with output driversin a tool mount. As described herein, motors in the tool mount can beconfigured to deliver rotary drive motions to the drivers in the robotictool. In other instances, the drivers in the robotic tool can beconfigured to receive linear drive motions from output drivers in thetool mount. For example, one or more linear drive motions can betransferred across the interface between the tool mount and the robotictool.

When a single motor is drivingly coupled to an output shaft, thetransmission assembly is in a low-torque operating state in comparisonto a high-torque operating state in which more than one motor isdrivingly coupled to the output shaft. The maximum torque deliverable tothe output shaft in the high-torque operating state is greater than themaximum torque deliverable to the output shaft in the low-torqueoperating state. In one instance, the maximum torque in the high-torqueoperating state can be double the maximum torque in the low-torqueoperating state. The maximum torques deliverable to the output shaft canbe based on the size and torque capabilities of the motors.

In one aspect, the robotic surgical system includes a processor and amemory communicatively coupled to the processor, as described herein.The memory stores instructions executable by the processor toselectively operably couple a first rotary driver and a second rotarydriver to output shafts of a tool housing, wherein one of the firstrotary driver and the second rotary driver is configured to supplytorque to an output shaft in a low-torque operating state, and whereinthe first rotary driver and the second rotary driver are configured toconcurrently supply torque to an output shaft in the high-torqueoperating state, as described herein.

In various aspects, the present disclosure provides a control circuit toselectively operably couple a first rotary driver and/or a second rotarydriver to an output shaft as described herein. In various aspects, thepresent disclosure provides a non-transitory computer readable mediumstoring computer readable instructions which, when executed, cause amachine to selectively operably couple a first rotary driver and/or asecond rotary driver to an output shaft, as described herein.

Another robotic surgical system is depicted in FIGS. 239 and 240 . Withreference to FIG. 239 , the robotic surgical system 13000 includesrobotic arms 13002, 13003, a control device 13004, and a console 13005coupled to the control device 13004. As illustrated in FIG. 239 , thesurgical system 13000 is configured for use on a patient 13013 lying ona patient table 13012 for performance of a minimally invasive surgicaloperation. The console 13005 includes a display device 13006 and inputdevices 13007, 13008. The display device 13006 is set up to displaythree-dimensional images, and the manual input devices 13007, 13008 areconfigured to allow a clinician to telemanipulate the robotic arms13002, 13003. Controls for a surgeon's console, such as the console13005, are further described in International Patent Publication No. WO2017/075121, filed Oct. 27, 2016, entitled HAPTIC FEEDBACK FOR A ROBOTICSURGICAL SYSTEM INTERFACE, which is herein incorporated by reference inits entirety.

Each of the robotic arms 13002, 13003 is made up of a plurality ofmembers connected through joints and includes a surgical assembly 13010connected to a distal end of a corresponding robotic arm 13002, 13003.Support of multiple arms is further described in U.S. Patent ApplicationPublication No. 2017/0071693, filed Nov. 11, 2016, entitled SURGICALROBOTIC ARM SUPPORT SYSTEMS AND METHODS OF USE, which is hereinincorporated by reference in its entirety. Various robotic armconfigurations are further described in International Patent PublicationNo. WO 2017/044406, filed Sep. 6, 2016, entitled ROBOTIC SURGICALCONTROL SCHEME FOR MANIPULATING ROBOTIC END EFFECTORS, which is hereinincorporated by reference in its entirety. In an exemplification, thesurgical assembly 13010 includes a surgical instrument 13020 supportingan end effector 13023. Although two robotic arms 13002, 13003, aredepicted, the surgical system 13000 may include a single robotic arm ormore than two robotic arms 13002, 13003. Additional robotic arms arelikewise connected to the control device 13004 and are telemanipulatablevia the console 13005. Accordingly, one or more additional surgicalassemblies 13010 and/or surgical instruments 13020 may also be attachedto the additional robotic arm(s).

The robotic arms 13002, 13003 may be driven by electric drives that areconnected to the control device 13004. According to an exemplification,the control device 13004 is configured to activate drives, for example,via a computer program, such that the robotic arms 13002, 13003 and thesurgical assemblies 13010 and/or surgical instruments 13020corresponding to the robotic arms 13002, 13003, execute a desiredmovement received through the manual input devices 13007, 13008. Thecontrol device 13004 may also be configured to regulate movement of therobotic arms 13002, 13003 and/or of the drives.

The control device 13004 may control a plurality of motors (for example,Motor 1 . . . n) with each motor configured to drive a pushing or apulling of one or more cables, such as cables coupled to the endeffector 13023 of the surgical instrument 13020. In use, as these cablesare pushed and/or pulled, the one or more cables affect operation and/ormovement of the end effector 13023. The control device 13004 coordinatesthe activation of the various motors to coordinate a pushing or apulling motion of one or more cables in order to coordinate an operationand/or movement of one or more end effectors 13023. For example,articulation of an end effector by a robotic assembly such as thesurgical assembly 13010 is further described in U.S. Patent ApplicationPublication No. 2016/0303743, filed Jun. 6, 2016, entitled WRIST AND JAWASSEMBLIES FOR ROBOTIC SURGICAL SYSTEMS and in International PatentPublication No. WO 2016/144937, filed Mar. 8, 2016, entitled MEASURINGHEALTH OF A CONNECTOR MEMBER OF A ROBOTIC SURGICAL SYSTEM, each of whichis herein incorporated by reference in its entirety. In anexemplification, each motor is configured to actuate a drive rod or alever arm to affect operation and/or movement of end effectors 13023 inaddition to, or instead of, one or more cables.

Driver configurations for surgical instruments, such as drivearrangements for a surgical end effector, are further described inInternational Patent Publication No. WO 2016/183054, filed May 10, 2016,entitled COUPLING INSTRUMENT DRIVE UNIT AND ROBOTIC SURGICAL INSTRUMENT,International Patent Publication No. WO 2016/205266, filed Jun. 15,2016, entitled ROBOTIC SURGICAL SYSTEM TORQUE TRANSDUCTION SENSING,International Patent Publication No. WO 2016/205452, filed Jun. 16,2016, entitled CONTROLLING ROBOTIC SURGICAL INSTRUMENTS WITHBIDIRECTIONAL COUPLING, and International Patent Publication No. WO2017/053507, filed Sep. 22, 2016, entitled ELASTIC SURGICAL INTERFACEFOR ROBOTIC SURGICAL SYSTEMS, each of which is herein incorporated byreference in its entirety. The modular attachment of surgicalinstruments to a driver is further described in International PatentPublication No. WO 2016/209769, filed Jun. 20, 2016, entitled ROBOTICSURGICAL ASSEMBLIES, which is herein incorporated by reference in itsentirety. Housing configurations for a surgical instrument driver andinterface are further described in International Patent Publication No.WO 2016/144998, filed Mar. 9, 2016, entitled ROBOTIC SURGICAL SYSTEMS,INSTRUMENT DRIVE UNITS, AND DRIVE ASSEMBLIES, which is hereinincorporated by reference in its entirety. Various endocutter instrumentconfigurations for use with the robotic arms 13002, 13003 are furtherdescribed in International Patent Publication No. WO 2017/053358, filedSep. 21, 2016, entitled SURGICAL ROBOTIC ASSEMBLIES AND INSTRUMENTADAPTERS THEREOF and International Patent Publication No. WO2017/053363, filed Sep. 21, 2016, entitled ROBOTIC SURGICAL ASSEMBLIESAND INSTRUMENT DRIVE CONNECTORS THEREOF, each of which is hereinincorporated by reference in its entirety. Bipolar instrumentconfigurations for use with the robotic arms 13002, 13003 are furtherdescribed in International Patent Publication No. WO 2017/053698, filedSep. 23, 2016, entitled ROBOTIC SURGICAL ASSEMBLIES ANDELECTROMECHANICAL INSTRUMENTS THEREOF, which is herein incorporated byreference in its entirety. Reposable shaft arrangements for use with therobotic arms 13002, 13003 are further described in International PatentPublication No. WO 2017/116793, filed Dec. 19, 2016, entitled ROBOTICSURGICAL SYSTEMS AND INSTRUMENT DRIVE ASSEMBLIES, which is hereinincorporated by reference in its entirety.

The control device 13004 includes any suitable logic control circuitadapted to perform calculations and/or operate according to a set ofinstructions. The control device 13004 can be configured to communicatewith a remote system “RS,” either via a wireless (e.g., Wi-Fi,Bluetooth, LTE, etc.) and/or wired connection. The remote system “RS”can include data, instructions and/or information related to the variouscomponents, algorithms, and/or operations of system 13000. The remotesystem “RS” can include any suitable electronic service, database,platform, cloud “C” (see FIG. 239 ), or the like. The control device13004 may include a central processing unit operably connected tomemory. The memory may include transitory type memory (e.g., RAM) and/ornon-transitory type memory (e.g., flash media, disk media, etc.). Insome exemplifications, the memory is part of, and/or operably coupledto, the remote system “RS.”

The control device 13004 can include a plurality of inputs and outputsfor interfacing with the components of the system 13000, such as througha driver circuit. The control device 13004 can be configured to receiveinput signals and/or generate output signals to control one or more ofthe various components (e.g., one or more motors) of the system 13000.The output signals can include, and/or can be based upon, algorithmicinstructions which may be pre-programmed and/or input by a user. Thecontrol device 13004 can be configured to accept a plurality of userinputs from a user interface (e.g., switches, buttons, touch screen,etc. of operating the console 13005) which may be coupled to remotesystem “RS.”

A memory 13014 can be directly and/or indirectly coupled to the controldevice 13004 to store instructions and/or databases includingpre-operative data from living being(s) and/or anatomical atlas(es). Thememory 13014 can be part of, and/or or operatively coupled to, remotesystem “RS.”

In accordance with an exemplification, the distal end of each roboticarm 13002, 13003 is configured to releasably secure the end effector13023 (or other surgical tool) therein and may be configured to receiveany number of surgical tools or instruments, such as a trocar orretractor, for example.

A simplified functional block diagram of a system architecture 13400 ofthe robotic surgical system 13010 is depicted in FIG. 240 . The systemarchitecture 13400 includes a core module 13420, a surgeon master module13430, a robotic arm module 13440, and an instrument module 13450. Thecore module 13420 serves as a central controller for the roboticsurgical system 13000 and coordinates operations of all of the othermodules 13430, 13440, 13450. For example, the core module 13420 mapscontrol devices to the arms 13002, 13003, determines current status,performs all kinematics and frame transformations, and relays resultingmovement commands. In this regard, the core module 13420 receives andanalyzes data from each of the other modules 13430, 13440, 13450 inorder to provide instructions or commands to the other modules 13430,13440, 13450 for execution within the robotic surgical system 13000.Although depicted as separate modules, one or more of the modules 13420,13430, 13440, and 13450 are a single component in otherexemplifications.

The core module 13420 includes models 13422, observers 13424, acollision manager 13426, controllers 13428, and a skeleton 13429. Themodels 13422 include units that provide abstracted representations (baseclasses) for controlled components, such as the motors (for example,Motor 1 . . . n) and/or the arms 13002, 13003. The observers 13424create state estimates based on input and output signals received fromthe other modules 13430, 13440, 13450. The collision manager 13426prevents collisions between components that have been registered withinthe system 13010. The skeleton 13429 tracks the system 13010 from akinematic and dynamics point of view. For example, the kinematics itemmay be implemented either as forward or inverse kinematics, in anexemplification. The dynamics item may be implemented as algorithms usedto model dynamics of the system's components.

The surgeon master module 13430 communicates with surgeon controldevices at the console 13005 and relays inputs received from the console13005 to the core module 13420. In accordance with an exemplification,the surgeon master module 13430 communicates button status and controldevice positions to the core module 13420 and includes a node controller13432 that includes a state/mode manager 13434, a fail-over controller13436, and a N-degree of freedom (“DOF”) actuator 13438.

The robotic arm module 13440 coordinates operation of a robotic armsubsystem, an arm cart subsystem, a set up arm, and an instrumentsubsystem in order to control movement of a corresponding arm 13002,13003. Although a single robotic arm module 13440 is included, it willbe appreciated that the robotic arm module 13440 corresponds to andcontrols a single arm. As such, additional robotic arm modules 13440 areincluded in configurations in which the system 13010 includes multiplearms 13002, 13003. The robotic arm module 13440 includes a nodecontroller 13442, a state/mode manager 13444, a fail-over controller13446, and a N-degree of freedom (“DOF”) actuator 13348.

The instrument module 13450 controls movement of an instrument and/ortool component attached to the arm 13002, 13003. The instrument module13450 is configured to correspond to and control a single instrument.Thus, in configurations in which multiple instruments are included,additional instrument modules 13450 are likewise included. In anexemplification, the instrument module 13450 obtains and communicatesdata related to the position of the end effector or jaw assembly (whichmay include the pitch and yaw angle of the jaws), the width of or theangle between the jaws, and the position of an access port. Theinstrument module 13450 has a node controller 13452, a state/modemanager 13454, a fail-over controller 13456, and a N-degree of freedom(“DOF”) actuator 13458.

The position data collected by the instrument module 13450 is used bythe core module 13420 to determine when the instrument is within thesurgical site, within a cannula, adjacent to an access port, or above anaccess port in free space. The core module 13420 can determine whetherto provide instructions to open or close the jaws of the instrumentbased on the positioning thereof. For example, when the position of theinstrument indicates that the instrument is within a cannula,instructions are provided to maintain a jaw assembly in a closedposition. When the position of the instrument indicates that theinstrument is outside of an access port, instructions are provided toopen the jaw assembly.

Additional features and operations of a robotic surgical system, such asthe surgical robot system depicted in FIGS. 239 and 240 , are furtherdescribed in the following references, each of which is hereinincorporated by reference in its entirety:

-   -   U.S. Patent Application Publication No. 2016/0303743, filed Jun.        6, 2016, entitled WRIST AND JAW ASSEMBLIES FOR ROBOTIC SURGICAL        SYSTEMS;    -   U.S. Patent Application Publication No. 2017/0071693, filed Nov.        11, 2016, entitled SURGICAL ROBOTIC ARM SUPPORT SYSTEMS AND        METHODS OF USE;    -   International Patent Publication No. WO 2016/144937, filed Mar.        8, 2016, entitled MEASURING HEALTH OF A CONNECTOR MEMBER OF A        ROBOTIC SURGICAL SYSTEM;    -   International Patent Publication No. WO 2016/144998, filed Mar.        9, 2016, entitled ROBOTIC SURGICAL SYSTEMS, INSTRUMENT DRIVE        UNITS, AND DRIVE ASSEMBLIES;    -   International Patent Publication No. WO 2016/183054, filed May        10, 2016, entitled COUPLING INSTRUMENT DRIVE UNIT AND ROBOTIC        SURGICAL INSTRUMENT;    -   International Patent Publication No. WO 2016/205266, filed Jun.        15, 2016, entitled ROBOTIC SURGICAL SYSTEM TORQUE TRANSDUCTION        SENSING;    -   International Patent Publication No. WO 2016/205452, filed Jun.        16, 2016, entitled CONTROLLING ROBOTIC SURGICAL INSTRUMENTS WITH        BIDIRECTIONAL COUPLING;    -   International Patent Publication No. WO 2016/209769, filed Jun.        20, 2016, entitled ROBOTIC SURGICAL ASSEMBLIES;    -   International Patent Publication No. WO 2017/044406, filed Sep.        6, 2016, entitled ROBOTIC SURGICAL CONTROL SCHEME FOR        MANIPULATING ROBOTIC END EFFECTORS;    -   International Patent Publication No. WO 2017/053358, filed Sep.        21, 2016, entitled SURGICAL ROBOTIC ASSEMBLIES AND INSTRUMENT        ADAPTERS THEREOF;    -   International Patent Publication No. WO 2017/053363, filed Sep.        21, 2016, entitled ROBOTIC SURGICAL ASSEMBLIES AND INSTRUMENT        DRIVE CONNECTORS THEREOF;    -   International Patent Publication No. WO 2017/053507, filed Sep.        22, 2016, entitled ELASTIC SURGICAL INTERFACE FOR ROBOTIC        SURGICAL SYSTEMS;    -   International Patent Publication No. WO 2017/053698, filed Sep.        23, 2016, entitled ROBOTIC SURGICAL ASSEMBLIES AND        ELECTROMECHANICAL INSTRUMENTS THEREOF;    -   International Patent Publication No. WO 2017/075121, filed Oct.        27, 2016, entitled HAPTIC FEEDBACK CONTROLS FOR A ROBOTIC        SURGICAL SYSTEM INTERFACE;    -   International Patent Publication No. WO 2017/116793, filed Dec.        19, 2016, entitled ROBOTIC SURGICAL SYSTEMS AND INSTRUMENT DRIVE        ASSEMBLIES.

The robotic surgical systems and features disclosed herein can beemployed with the robotic surgical system of FIGS. 239 and 240 . Thereader will further appreciate that various systems and/or featuresdisclosed herein can also be employed with alternative surgical systemsincluding the computer-implemented interactive surgical system 100, thecomputer-implemented interactive surgical system 200, the roboticsurgical system 110, the robotic hub 122, the robotic hub 222, and/orthe robotic surgical system 15000, for example.

In various instances, a robotic surgical system can include a roboticcontrol tower, which can house the control unit of the system. Forexample, the control unit 13004 of the robotic surgical system 13000(FIG. 239 ) can be housed within a robotic control tower. The roboticcontrol tower can include a robotic hub such as the robotic hub 122(FIG. 2 ) or the robotic hub 222 (FIG. 9 ), for example. Such a robotichub can include a modular interface for coupling with one or moregenerators, such as an ultrasonic generator and/or a radio frequencygenerator, and/or one or more modules, such as an imaging module,suction module, an irrigation module, a smoke evacuation module, and/ora communication module.

A robotic hub can include a situational awareness module, which can beconfigured to synthesize data from multiple sources to determine anappropriate response to a surgical event. For example, a situationalawareness module can determine the type of surgical procedure, step inthe surgical procedure, type of tissue, and/or tissue characteristics,as further described herein. Moreover, such a module can recommend aparticular course of action or possible choices to the robotic systembased on the synthesized data. In various instances, a sensor systemencompassing a plurality of sensors distributed throughout the roboticsystem can provide data, images, and/or other information to thesituational awareness module. Such a situational awareness module can beincorporated into a control unit, such as the control unit 13004, forexample. In various instances, the situational awareness module canobtain data and/or information from a non-robotic surgical hub and/or acloud, such as the surgical hub 106 (FIG. 1 ), the surgical hub 206(FIG. 10 ), the cloud 104 (FIG. 1 ), and/or the cloud 204 (FIG. 9 ), forexample. Situational awareness of a surgical system is further disclosedherein and in U.S. Provisional Patent Application Ser. No. 62/611,341,entitled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017, and U.S.Provisional Patent Application Ser. No. 62/611,340, entitled CLOUD-BASEDMEDICAL ANALYTICS, filed Dec. 28, 2017, the disclosure of each of whichis herein incorporated by reference in its entirety.

In certain instances, the activation of a surgical tool at certain timesduring a surgical procedure and/or for certain durations may causetissue trauma and/or may prolong a surgical procedure. For example, arobotic surgical system can utilize an electrosurgical tool having anenergy delivery surface that should only be energized when a thresholdcondition is met. In one example, the energy delivery surface shouldonly be activated when the energy delivery surface is in contact withthe appropriate, or targeted, tissue. As another example, a roboticsurgical system can utilize a suction element that should only beactivated when a threshold condition is met, such as when an appropriatevolume of fluid is present. Due to visibility restrictions, evolvingsituations, and the multitude of moving parts during a robotic surgicalprocedure, it can be difficult for a clinician to determine and/ormonitor certain conditions at the surgical site. For example, it can bedifficult to determine if an energy delivery surface of anelectrosurgical tool is in contact with tissue. It can also be difficultto determine if a particular suctioning pressure is sufficient for thevolume of fluid in the proximity of the suctioning port.

Moreover, a plurality of surgical devices can be used in certain roboticsurgical procedures. For example, a robotic surgical system can use oneor more surgical tools during the surgical procedure. Additionally, oneor more handheld instruments can also be used during the surgicalprocedure. One or more of the surgical devices can include a sensor. Forexample, multiple sensors can be positioned around the surgical siteand/or the operating room. A sensor system including the one or moresensors can be configured to detect one or more conditions at thesurgical site. For example, data from the sensor system can determine ifa surgical tool mounted to the surgical robot is being used and/or if afeature of the surgical tool should be activated. More specifically, asensor system can detect if an electrosurgical device is positioned inabutting contact with tissue, for example. As another example, a sensorsystem can detect if a suctioning element of a surgical tool is applyinga sufficient suctioning force to fluid at the surgical site.

When in an automatic activation mode, the robotic surgical system canautomatically activate one or more features of one or more surgicaltools based on data, images, and/or other information received from thesensor system. For example, an energy delivery surface of anelectrosurgical tool can be activated upon detecting that theelectrosurgical tool is in use (e.g. positioned in abutting contact withtissue). As another example, a suctioning element on a surgical tool canbe activated when the suction port is moved into contact with a fluid.In certain instances, the surgical tool can be adjusted based on thesensed conditions.

A robotic surgical system incorporating an automatic activation mode canautomatically provide a scenario-specific result based on detectedcondition(s) at the surgical site. The scenario-specific result can beoutcome-based, for example, and can streamline the decision-makingprocess of the clinician. In certain instances, such an automaticactivation mode can improve the efficiency and/or effectiveness of theclinician. For example, the robotic surgical system can aggregate datato compile a more complete view of the surgical site and/or the surgicalprocedure in order to determine the best possible course of action.Additionally or alternatively, in instances in which the clinician makesfewer decisions, the clinician can be better focused on other tasksand/or can process other information more effectively.

In one instance, a robotic surgical system can automatically adjust asurgical tool based on the proximity of the tool to avisually-detectable need and/or the situational awareness of the system.Referring to FIGS. 241A and 241B, an ultrasonic surgical tool for arobotic system 13050 is depicted in two different positions. In a firstposition, as depicted in FIG. 241A, the blade 13052 of an ultrasonicsurgical tool 13050 is positioned out of contact with tissue 13060. Insuch a position, a sensor on the ultrasonic surgical tool 13050 candetect a high resistance. When the resistance detected is above athreshold value, the ultrasonic blade 13052 can be de-energized.Referring now to FIG. 241B, the ultrasonic blade 13052 is depicted in asecond position in which the distal end of the blade 13052 is positionedin abutting contact with tissue 13060. In such instances, a sensor onthe ultrasonic surgical tool 13050 can detect a low resistance. When thedetected resistance is below a threshold value, the ultrasonic blade13052 can be activated such that therapeutic energy is delivered to thetissue 13060. Alternative sensor configurations are also envisioned andvarious sensors are further described herein.

Referring to FIGS. 242A and 242B, another surgical tool, a monopolarcautery pencil 13055, is depicted in two different positions. In a firstposition, as depicted in FIG. 242A, the monopolar cautery pencil 13055is positioned out of contact with tissue. In such a position, a sensoron the monopolar cautery pencil 13055 can detect a high resistance. Whenthe resistance detected is above a threshold value, the monopolarcautery pencil 13055 can be de-energized. Referring now to FIG. 242B,the monopolar cautery pencil 13055 is depicted in a second position inwhich the distal end of the monopolar cautery pencil 13055 is positionedin abutting contact with tissue. In such instances, a sensor on themonopolar cautery pencil 13055 can detect a low resistance. When thedetected resistance is below a threshold value, the monopolar cauterypencil 13055 can be activated such that therapeutic energy is deliveredto the tissue. Alternative sensor configurations are also envisioned andvarious sensors are further described herein.

FIG. 243 shows a graphical display 13070 of continuity C and current Iover time t for the ultrasonic surgical tool 13050 of FIGS. 241A and241B. Similarly, the monopolar cautery pencil 13055 can generate agraphical display similar in many respects to the graphical display13070, in certain instances. In the graphical display 13070, continuityC is represented by a dotted line, and current I is represented by asolid line. When the resistance is high and above a threshold value, thecontinuity C can also be high. The threshold value can be between 40 and400 ohms, for example. At time A′, the continuity C can decrease belowthe threshold value, which can indicate a degree of tissue contact. As aresult, the robotic surgical system can automatically activate advancedenergy treatment of the tissue. The ultrasonic transducer currentdepicted in FIG. 243 increases from time A′ to B′ when the continuityparameters indicate the degree of tissue contact. In various instances,the current I can be capped at a maximum value indicated at B′, whichcan correspond to an open jaw transducer limit, such as in instances inwhich the jaw is not clamped, as shown in FIGS. 241A and 241B. Invarious instances, the situational awareness module of the roboticsurgical system may indicate that the jaw is unclamped. Referring againto the graphical display 13070 in FIG. 243 , energy is applied untiltime C′, at which time a loss of tissue contact is indicated by theincrease in continuity C above the threshold value. As a result, theultrasonic transducer current I can decrease to zero as the ultrasonicblade is de-energized.

In various instances, a sensor system can be configured to detect atleast one condition at the surgical site. For example, a sensor of thesensor system can detect tissue contact by measuring continuity alongthe energy delivery surface of the ultrasonic blade. Additionally oralternatively, the sensor system can include one or more additionalsensors positioned around the surgical site. For example, one or moresurgical tools and/or instruments being used in the surgical procedurecan be configured to detect a condition at the surgical site. The sensorsystem can be in signal communication with a processor of the roboticsurgical system. For example, the robotic surgical system can include acentral control tower including a control unit housing a processor andmemory, as further described herein. The processor can issue commands tothe surgical tool based on inputs from the sensor system. In variousinstances, situational awareness can also dictate and/or influence thecommands issued by the processor.

Turning now to FIG. 244 , an end effector 196400 includes RF datasensors 196406, 196408 a, 196408 b located on jaw member 196402. The endeffector 196400 includes jaw member 196402 and an ultrasonic blade196404. The jaw member 196402 is shown clamping tissue 196410 locatedbetween the jaw member 196402 and the ultrasonic blade 196404. A firstsensor 196406 is located in a center portion of the jaw member 196402.Second and third sensors 196408 a, 196408 b, respectively, are locatedon lateral portions of the jaw member 196402. The sensors 196406, 196408a, 196408 b are mounted or formed integrally with a flexible circuit196412 (shown more particularly in FIG. 245 ) configured to be fixedlymounted to the jaw member 196402.

The end effector 196400 is an example end effector for various surgicaldevices described herein. The sensors 196406, 196408 a, 196408 b areelectrically connected to a control circuit via interface circuits. Thesensors 196406, 196408 a, 196408 b are battery powered and the signalsgenerated by the sensors 196406, 196408 a, 196408 b are provided toanalog and/or digital processing circuits of the control circuit.

In one aspect, the first sensor 196406 is a force sensor to measure anormal force F₃ applied to the tissue 196410 by the jaw member 196402.The second and third sensors 196408 a, 196408 b include one or moreelements to apply RF energy to the tissue 196410, measure tissueimpedance, down force F₁, transverse forces F₂, and temperature, amongother parameters. Electrodes 196409 a, 196409 b are electrically coupledto an energy source such as an electrical circuit and apply RF energy tothe tissue 196410. In one aspect, the first sensor 196406 and the secondand third sensors 196408 a, 196408 b are strain gauges to measure forceor force per unit area. It will be appreciated that the measurements ofthe down force F₁, the lateral forces F₂, and the normal force F₃ may bereadily converted to pressure by determining the surface area upon whichthe force sensors 196406, 196408 a, 196408 b are acting upon.Additionally, as described with particularity herein, the flexiblecircuit 196412 may include temperature sensors embedded in one or morelayers of the flexible circuit 196412. The one or more temperaturesensors may be arranged symmetrically or asymmetrically and providetissue 196410 temperature feedback to control circuits of an ultrasonicdrive circuit and an RF drive circuit.

One or more sensors such as a magnetic field sensor, a strain gauge, apressure sensor, a force sensor, an inductive sensor such as, forexample, an eddy current sensor, a resistive sensor, a capacitivesensor, an optical sensor, and/or any other suitable sensor, may beadapted and configured to measure tissue compression and/or impedance.

FIG. 245 illustrates one aspect of the flexible circuit 196412 shown inFIG. 244 in which the sensors 196406, 196408 a, 196408 b may be mountedto or formed integrally therewith. The flexible circuit 196412 isconfigured to fixedly attach to the jaw member 196402. As shownparticularly in FIG. 245 , asymmetric temperature sensors 196414 a,196414 b are mounted to the flexible circuit 196412 to enable measuringthe temperature of the tissue 196410 (FIG. 244 ).

The reader will appreciate that alternative surgical tools can beutilized in the automatic activation mode described above with respectto FIGS. 241A-245 .

FIG. 246 is a flow chart 13150 depicting an automatic activation mode13151 of a surgical tool. In various instances, the robotic surgicalsystem and processor thereof is configured to implement the processesindicated in FIG. 246 . Initially, a sensor system is configured todetect a condition at step 13152. The detected condition is communicatedto a processor, which compares the detected condition to a thresholdparameter at step 13154. The threshold parameter can be a maximum value,minimum value, or range of values. If the sensed condition is anout-of-bounds condition, the processor can adjust the surgical functionat step 13156 and the processor can repeat the comparison process ofsteps 13152 and 13154. If the sensed condition is not an out-of-boundscondition, no adjustment is necessary (13158) and the comparison processof steps 13152 and 13154 can be repeated again.

In various instances, the robotic surgical system can permit a manualoverride mode 13153. For example, upon activation of the manual overrideinput 13160, such as by a clinician, the surgical system can exit theautomatic activation mode 13151 at step 13162 depicted in FIG. 246 . Insuch instances, even when a sensed condition is an out-of-boundscondition, the surgical function would not be automatically adjusted bythe processor. However, in such instances, the processor can issue awarning or recommendation to the clinician recommending a particularcourse of action based on the sensed condition(s).

In various instances, an automatic activation mode can be utilized witha robotic surgical system including a suctioning feature. In oneinstance, a robotic surgical system can communicate with a suctionand/or irrigation tool. For example, a suction and/or irrigation device(see module 128 in FIG. 3 ) can communicate with a robotic surgicalsystem via the surgical hub 106 (FIG. 1 ) and/or the surgical hub 206(FIG. 9 ) and a suction and/or irrigation tool can be mounted to arobotic arm. The suction/irrigation device can include a distal suctionport and a sensor. In another instance, a robotic surgical tool, such asan electrosurgical tool, can include a suctioning feature and a suctionport on the end effector of the tool.

Referring to FIG. 247 , when a suction port on an end effector 13210 ismoved into contact with a fluid, a processor of the robotic surgicalsystem can automatically activate the suction feature. For example, afluid detection sensor 13230 on the tool 13200 can detect fluid 13220 inthe proximity of the tool 13200 and/or contacting the tool 13200. Thefluid detection sensor 13230 can be a continuity sensor, for example.The fluid detection sensor 13230 can be in signal communication with theprocessor such that the processor is configured to receive input and/orfeedback from the fluid detection sensor 13230. In certain instances,the suctioning feature can be automatically activated when the suctionport is moved into proximity with a fluid 13220. For example, when thesuction port moves within a predefined spatial range of a fluid 13220,the suction feature can be activated by the processor. The fluid 13220can be saline, for example, which can be provided to the surgical siteto enhance conductivity and/or irrigate the tissue.

In various instances, the tool can be a smoke evacuation tool and/or caninclude a smoke evacuation system, for example. A detail view of an endeffector 13210 of a bipolar radio-frequency surgical tool 13200 is shownin FIG. 247 . The end effector 13210 is shown in a clampedconfiguration. Moreover, smoke and steam 13220 from an RF weldaccumulate around the end effector 13210. In various instances, toimprove visibility and efficiency of the tool 13200, the smoke and steam13220 at the surgical site can be evacuated along a smoke evacuationchannel 13240 extending proximally from the end effector. The evacuationchannel 13240 can extend through the shaft 13205 of the surgical tool13200 to the interface of the surgical tool 13200 and the robot. Theevacuation channel 13240 can be coupled to a pump for drawing the smokeand/or steam 13220 along the smoke evacuation channel 13240 within theshaft 13205 of the surgical tool 13200. In various instances, thesurgical tool 13200 can include insufflation, cooling, and/or irrigationcapabilities, as well.

In one instance, the intensity of the suction pressure can beautomatically adjusted based on a measured parameter from one or moresurgical devices. In such instances, the suction pressure can varydepending on the sensed parameters. Suction tubing can include a sensorfor detecting the volume of fluid being extracted from the surgicalsite. When increased volumes of fluid are being extracted, the power tothe suction feature can be increased such that the suctioning pressureis increased. Similarly, when decreased volumes of fluid are beingextracted, the power to the suction feature can be decreased such thatthe suctioning pressure is decreased.

In various instances, the sensing system for a suction tool can includea pressure sensor. The pressure sensor can detect when an occlusion isobstructing, or partially obstructing, the fluid flow. The pressuresensor can also detect when the suction port is moved into abuttingcontact with tissue. In such instances, the processor can reduce and/orpause the suctioning force to release the tissue and/or clear theobstruction. In various instances, the processor can compare thedetected pressure to a threshold maximum pressure. Exceeding the maximumthreshold pressure may lead to unintentional tissue trauma from thesuctioning tool. Thus, to avoid such trauma, the processor can reduceand/or pause the suctioning force to protect the integrity of tissue inthe vicinity thereof.

A user can manually override the automatic adjustments implemented inthe automatic activation mode(s) described herein. The manual overridecan be a one-time adjustment to the surgical tool. In other instances,the manual override can be a setting that turns off the automaticactivation mode for a specific surgical action, a specific duration,and/or a global override for the entire procedure.

In one aspect, the robotic surgical system includes a processor and amemory communicatively coupled to the processor, as described herein.The processor is communicatively coupled to a sensor system, and thememory stores instructions executable by the processor to determine ause of a robotic tool based on input from the sensor system and toautomatically energize an energy delivery surface of the robotic toolwhen the use is determined, as described herein.

In various aspects, the present disclosure provides a control circuit toautomatically energize an energy delivery surface, as described herein.In various aspects, the present disclosure provides a non-transitorycomputer readable medium storing computer readable instructions which,when executed, cause a machine to automatically energize an energydelivery surface of a robotic tool, as described herein.

In one aspect, the robotic surgical system includes a processor and amemory communicatively coupled to the processor, as described herein.The processor is communicatively coupled to a fluid detection sensor,and the memory stores instructions executable by the processor toreceive input from the fluid detection sensor and to automaticallyactivate a suctioning mode when fluid is detected, as described herein.

In various aspects, the present disclosure provides a control circuit toautomatically activate a suctioning mode, as described herein. Invarious aspects, the present disclosure provides a non-transitorycomputer readable medium storing computer readable instructions which,when executed, cause a machine to automatically activate a suctioningmode, as described herein.

Multiple surgical devices, including a robotic surgical system andvarious handheld instruments, can be used by a clinician during aparticular surgical procedure. When manipulating one or more robotictools of the robotic surgical system, a clinician is often positioned ata surgeon's command console or module, which is also referred to as aremote control console. In various instances, the remote control consoleis positioned outside of a sterile field and, thus, can be remote to thesterile field and, in some instances, remote to the patient and even tothe operating room. If the clinician desires to use a handheldinstrument, the clinician may be required to step away from the remotecontrol console. At this point, the clinician may be unable to controlthe robotic tools. For example, the clinician may be unable to adjustthe position or utilize the functionality of the robotic tools. Uponstepping away from the remote control console, the clinician may alsolose sight of one or more displays on the robotic surgical system. Theseparation between the control points for the handheld instruments andthe robotic surgical system may inhibit the effectiveness with which theclinician can utilize the surgical devices, both robotic tools andsurgical instruments, together.

In various instances, an interactive secondary display is configured tobe in signal communication with the robotic surgical system. Theinteractive secondary display includes a control module in variousinstances. Moreover, the interactive secondary display is configured tobe wireless and movable around an operating room. In various instances,the interactive secondary display is positioned within a sterile field.In one instance, the interactive secondary display allows the clinicianto manipulate and control the one or more robotic tools of the roboticsurgical system without having to be physically present at the remotecontrol console. In one instance, the ability for the clinician tooperate the robotic surgical system away from the remote control consoleallows multiple devices to be used in a synchronized manner. As a safetymeasure, in certain instances, the remote control console includes anoverride function configured to prohibit control of the robotic tools bythe interactive secondary display.

FIG. 248 depicts a surgical system 13100 for use during a surgicalprocedure that utilizes a surgical instrument 13140 and a roboticsurgical system 13110. The surgical instrument 13140 is a poweredhandheld instrument. The surgical instrument 13140 can be a radiofrequency (RF) instrument, an ultrasonic instrument, a surgical stapler,and/or a combination thereof, for example. The surgical instrument 13140includes a display 13142 and a processor 13144. In certain instances,the handheld surgical instrument 13140 can be a smart or intelligentsurgical instrument having a plurality of sensors and a wirelesscommunication module.

The robotic surgical system 13110 includes a robot 13112 including atleast one robotic tool 13117 configured to perform a particular surgicalfunction. The robotic surgical system 13110 is similar in many respectsto robotic surgical system 13000 discussed herein. The robotic tool13117 is movable in a space defined by a control envelope of the roboticsurgical system 13110. In various instances, the robotic tool 13117 iscontrolled by various clinician inputs at a remote control console13116. In other words, when a clinician applies an input at the remotecontrol console 13116, the clinician is away from the patient's body andoutside of a sterile field 13138. Clinician input to the remote controlconsole 13116 is communicated to a robotic control unit 13114 thatincludes a robot display 13113 and a processor 13115. The processor13115 directs the robotic tool(s) 13117 to perform the desiredfunction(s).

In various instances, the surgical system 13100 includes a surgical hub13120, which is similar in many respects to the hub 106, the hub 206,the robotic hub 122, or the robotic hub 222, for example. The surgicalhub 13120 is configured to enhance cooperative and/or coordinated usageof the robotic surgical system 13110 and the surgical instrument(s)13140. The surgical hub 13120 is in signal communication with thecontrol unit 13114 of the robotic surgical system 13110 and theprocessor 13144 of the surgical instrument(s) 13140. In variousinstances, a signal is transmitted through a wireless connection,although any suitable connection can be used to facilitate thecommunication. The control unit 13114 of the robotic surgical system13110 is configured to send information to the surgical hub 13120regarding the robotic tool(s) 13117. Such information includes, forexample, a position of the robotic tool(s) 13117 within the surgicalsite, an operating status of the robotic tool(s) 13117, a detected forceby the robotic tool(s), and/or the type of robotic tool(s) 13117attached to the robotic surgical system 13110, although any relevantinformation and/or operating parameters can be communicated. Examples ofsurgical hubs are further described herein and in U.S. ProvisionalPatent Application Ser. No. 62/611,341, entitled INTERACTIVE SURGICALPLATFORM, filed Dec. 28, 2017, the disclosure of which is hereinincorporated by reference in its entirety.

In other instances, the robotic surgical system 13110 can encompass thesurgical hub 13120 and/or the control unit 13114 can be incorporatedinto the surgical hub 13120. For example, the robotic surgical system13110 can include a robotic hub including a modular control tower thatincludes a computer system and a modular communication hub. One or moremodules can be installed in the modular control tower of the robotichub. Examples of robotic hubs are further described herein and in U.S.Provisional Patent Application Ser. No. 62/611,341, entitled INTERACTIVESURGICAL PLATFORM, filed Dec. 28, 2017, the disclosure of which isherein incorporated by reference in its entirety.

The processor 13144 of the surgical instrument(s) 13140 is configured tosend information to the surgical hub 13120 regarding the surgicalinstrument 13140. Such information includes, for example, a position ofthe surgical instrument(s) 13140 within the surgical site, an operatingstatus of the surgical instrument(s) 13140, a detected force by thesurgical instrument(s) 13140, and/or identification informationregarding the surgical instrument(s) 13140, although any relevantinformation and/or operating parameters can be sent to the surgical hub.

In various instances, a hub display 13125 is in signal communicationwith the surgical hub 13120 and may be incorporated into the modularcontrol tower, for example. The hub display 13125 is configured todisplay information received from the robotic surgical system 13110 andthe surgical instrument(s) 13140. The hub display 13125 can be similarin many respects to the visualization system 108 (FIG. 1 ), for example.In one aspect, the hub display 13125 can include an array of displayssuch as video monitors and/or heads-up displays around the operatingroom, for example.

In various instances, the surgical hub 13120 is configured to recognizewhen the surgical instrument 13140 is activated by a clinician viawireless communication signal(s). Upon activation, the surgicalinstrument 13140 is configured to send identification information to thesurgical hub 13120. Such identification information may include, forexample, a model number of the surgical instrument, an operating statusof the surgical instrument, and/or a location of the surgicalinstrument, although other suitable device parameters can becommunicated. In various instances, the surgical hub 13120 is configuredto utilize the communicated information to assess the compatibility ofthe surgical instrument 13140 with the capabilities of the surgical hub13120. Examples of capabilities of the surgical hub with compatiblesurgical instruments are further discussed herein.

In various instances, the control unit 13114 of the robotic surgicalsystem 13110 is configured to communicate a video feed to the surgicalhub 13120, and the surgical hub 13120 is configured to communicate theinformation, or a portion thereof, to the surgical instrument 13140,which can replicate a portion of the robot display 13113, or otherinformation from the robotic surgical system 13110, on a display 13142of the surgical instrument 13140. In other instances, the roboticsurgical system 13110 (e.g. the control unit 13114 or surgical tool13117) can communicate directly with the surgical instrument 13140, suchas when the robotic surgical system 13110 includes a robotic hub and/orthe surgical tool 13117 includes a wireless communication module, forexample. The reproduction of a portion of the robot display 13113 on thesurgical instrument 13140 allows the clinician to cooperatively use bothsurgical devices by providing, for example, alignment data to achieveintegrated positioning of the surgical instrument 13140 relative to therobotic tool(s) 13117. In various instances, the clinician is able toremove any unwanted information displayed on the display 13142 of thesurgical instrument 13140.

Referring still to FIG. 248 , in various instances, the surgical system13100 further includes an interactive secondary display 13130 within thesterile field 13138. The interactive secondary display 13130 is also alocal control module within the sterile field 13138. The remote controlconsole 13116, or the primary control, can be positioned outside thesterile field 13138. For example, the interactive secondary display13130 can be a handheld mobile electronic device, such as an iPad®tablet, which can be placed on a patient or the patient's table during asurgical procedure. For example, the interactive secondary display 13130can be placed on the abdomen or leg of the patient during the surgicalprocedure. In other instances, the interactive secondary display 13130can be incorporated into the surgical instrument 13140 within thesterile field 13138. In various instances, the interactive secondarydisplay 13130 is configured to be in signal communication with therobotic surgical system 13110 and/or the surgical instrument 13140. Insuch instances, the interactive secondary display 13130 is configured todisplay information received from the robotic tool(s) 13117 (forexample, robotic tool 1, robotic tool 2, . . . robotic tool n) and thesurgical instruments 13140 (for example, surgical instrument 1, surgicalinstrument 2, . . . surgical instrument n). The interactive secondarydisplay 13130 depicts tool information 13133 and instrument information13135 thereon. In various instances, the user is able to interact withthe interactive secondary display 13130 to customize the size and/orlocation of the information displayed.

Referring still to FIG. 248 , in various instances, the surgical hub13120 is configured to transmit robot status information of the surgicalrobot system 13100 to the surgical instrument 13140, and the surgicalinstrument 13140 is configured to display the robot status informationon the display 13142 of the surgical instrument 13140.

In various instances, the display 13142 of the surgical instrument 13140is configured to communicate commands through the surgical hub 13120 tothe control unit 13114 of the robotic surgical system 13110. Afterviewing and interpreting the robot status information displayed on thedisplay 13142 of the surgical instrument 13140 as described herein, aclinician may want to utilize one or more functions of the roboticsurgical system 13110. Using the buttons and/or a touch-sensitivedisplay 13142 on the surgical instrument 13140, the clinician is able toinput a desired utilization of and/or adjustment to the robotic surgicalsystem 13110. The clinician input is communicated from the surgicalinstrument 13140 to the surgical hub 13120. The surgical hub 13120 isthen configured to communicate the clinician input to the control unit13114 of the robotic surgical system 13110 for implementation of thedesired function. In other instances, the handheld surgical instrument13140 can communicate directly with the control unit 13114 of therobotic surgical system 13110, such as when the robotic surgical system13110 includes a robotic hub, for example.

In various instances, the surgical hub 13120 is in signal communicationwith both the robotic surgical system 13110 and the surgical instrument13140, allowing the surgical system 13100 to adjust multiple surgicaldevices in a synchronized, coordinated, and/or cooperative manner. Theinformation communicated between the surgical hub 13120 and the varioussurgical devices includes, for example, surgical instrumentidentification information and/or the operating status of the varioussurgical devices. In various instances, the surgical hub 13120 isconfigured to detect when the surgical instrument 13140 is activated. Inone instance, the surgical instrument 13140 is an ultrasonic dissector.Upon activation of the ultrasonic dissector, the surgical hub 13120 isconfigured to communicate the received activation information to thecontrol unit 13114 of the robotic surgical system 13110.

In various instances, the surgical hub 13120 automatically communicatesthe information to the control unit 13114 of the robotic surgical system13110. The reader will appreciate that the information can becommunicated at any suitable time, rate, interval and/or schedule. Basedon the information received from the surgical hub 13120, the controlunit 13114 of the robotic surgical system 13110 is configured to decidewhether to activate at least one robotic tool 13117 and/or activate aparticular operating mode, such as a smoke evacuation mode, for example.For example, upon activation of a surgical tool that is known togenerate, or possibly generate, smoke and/or contaminants at thesurgical site, such as an ultrasonic dissector, the robotic surgicalsystem 13110 can automatically activate the smoke evacuation mode or cancue the surgeon to activate the smoke evacuation mode. In variousinstances, the surgical hub 13120 is configured to continuouslycommunicate additional information to the control unit 13114 of therobotic surgical system 13110, such as various sensed tissue conditions,in order to adjust, continue, and/or suspend further movement of therobotic tool 13117 and/or the entered operating mode.

In various instances, the surgical hub 13120 may calculate parameters,such as smoke generation intensity, for example, based on the additionalinformation communicated from the surgical instrument 13140. Uponcommunicating the calculated parameter to the control unit 13114 of therobotic surgical system 13110, the control unit 13114 is configured tomove at least one robotic tool and/or adjust the operating mode toaccount for the calculated parameter. For example, when the roboticsurgical system 13110 enters the smoke evacuation mode, the control unit13114 is configured to adjust a smoke evacuation motor speed to beproportionate to the calculated smoke generation intensity.

In certain instances, an ultrasonic tool mounted to the robot 13112 caninclude a smoke evacuation feature that can be activated by the controlunit 13114 to operate in a smoke evacuation mode. In other instances, aseparate smoke evacuation device can be utilized. For example, a smokeevacuation tool can be mounted to another robotic arm and utilizedduring the surgical procedure. In still other instances, a smokeevacuation instrument that is separate from the robotic surgical system13110 can be utilized. The surgical hub 13120 can coordinatecommunication between the robotically-controlled ultrasonic tool and thesmoke evacuation instrument, for example.

In FIGS. 249-252 , various surgical devices and components thereof aredescribed with reference to a colon resection procedure. The reader willappreciate that the surgical devices, systems, and procedures describedwith respect to those figures are an exemplary application of the systemof FIG. 248 . Referring now to FIG. 249 , a handle portion 13202 of ahandheld surgical instrument 13300 is depicted. In certain aspects, thehandheld surgical instrument 13300 corresponds to the surgicalinstrument 13140 of the surgical system 13100 in FIG. 248 . In oneinstance, the handheld surgical instrument 13300 is a powered circularstapler and includes a display 13310 on the handle portion 13302thereof.

Before pairing the handheld surgical instrument 13300 to a roboticsurgical system (e.g. the robotic surgical system 13110 in FIG. 248 )via the surgical hub13320 (FIG. 250 ), as described herein, the display13310 on the handle 13302 of the handheld surgical instrument 13300 caninclude information regarding the status of the instrument 13300, suchas the clamping load 13212, the anvil status 13214, and/or theinstrument or cartridge status 13216, for example. In various instances,the display 13310 of the handheld surgical instrument 13300 includes analert 13318 to the user that communicates the status of the firingsystem. In various instances, the display 13310 is configured to displaythe information in a manner that communicates the most importantinformation to the user. For example, in various instances, the display13310 is configured to display warning information in a larger size, ina flashing manner, and/or in a different color. When the handheldsurgical instrument 13300 is not paired with a surgical hub, the display13310 can depict information gathered only from the handheld surgicalinstrument 13300 itself.

Referring now to FIG. 250 , after pairing the handheld surgicalinstrument 13300 with the surgical hub 13320, as described herein withrespect to FIG. 248 , for example, the information detected anddisplayed by the handheld surgical instrument 13300 can be communicatedto the surgical hub 13320 and displayed on a hub display (e.g. the hubdisplay 13125 of FIG. 248 ). Additionally or alternatively, theinformation can be displayed on the display of the robotic surgicalsystem. Additionally or alternatively, the information can be displayedon the display 13310 on the handle portion 13302 of the handheldsurgical instrument 13300. In various instances, a clinician can decidewhat information is displayed at the one or multiple locations. Asmentioned above, in various instances, the clinician is able to removeany unwanted information displayed on the display 13310 of the handheldsurgical instrument 13300, the display of the robotic surgical system,and/or the display on the hub display.

Referring still to FIG. 250 , after pairing the handheld surgicalinstrument 13300 with the robotic surgical system, the display 13310 onthe handle portion 13302 of the handheld surgical instrument 13300 canbe different than the display 13310 on the handheld surgical instrument13300 before pairing with the robotic surgical system. For example,procedural information from the surgical hub 13320 and/or roboticsurgical system can be displayed on the powered circular stapler. Forexample, as seen in FIG. 250 , robot status information includingalignment information 13312 from the surgical hub 13320 and one or moreretraction tensions 13316, 13317 exerted by a robotic tool on particulartissue(s), is displayed on the display 13310 of the handheld surgicalinstrument 13300 for the convenience of the clinician. In variousinstances, the display 13310 of the handheld surgical instrument 13300includes an alert 13318 to the user that communicates a parametermonitored by the surgical hub 13320 during a surgical procedure. Invarious instances, the display 13310 is configured to display theinformation in a manner that communicates the most important informationto the user. For example, in various instances, the display 13310 isconfigured to display warning information in a larger size, in aflashing manner, and/or in a different color.

Referring still to FIG. 250 , the display 13310 of the handheld surgicalinstrument 13300 is configured to display information regarding one ormore retraction tensions 13316, 13317 exerted by one or more devicesduring a surgical procedure involving one or more robotic tools. Forexample, the handheld surgical instrument 13300, the powered circularstapler, is involved a the colon resection procedure of FIG. 251 . Inthis procedure, one device (e.g. a robotic tool) is configured to graspcolonic tissue and another device (e.g. the handheld circular stapler)is configured to grasp rectal tissue. As the devices move apart from oneanother, the force of retracting the colonic tissue F_(RC) and the forceof retracting the rectal tissue F_(RR) are monitored. In the illustratedexample, an alert notification 13318 is issued to the user as the forceof retracting the colonic tissue has exceeded a predetermined threshold.Predetermined thresholds for both retracting forces F_(RC), F_(RR) areindicated by horizontal dotted lines on the display 13310. The user isnotified when one or both thresholds are surpassed and/or reached in aneffort to minimize damage and/or trauma to the surrounding tissue.

In FIG. 252 , graphical displays 13330, 13340 of retracting forcesF_(RC), F_(RR) are illustrated. In the circumstances illustrated in thegraphical displays 13330, 13340, the user is notified whenpre-determined thresholds are exceeded, depicted by the shaded region13332 of the graphical display 13330, indicating that the retractingforce of the colonic tissue F_(RC) has exceeded a predeterminedthreshold of 0.5 lbs.

In certain instances, it can be difficult to align the end effector of acircular stapler with targeted tissue during a colorectal procedurebecause of visibility limitations. For example, referring again to FIG.251 , during a colon resection, the surgical instrument 13300, acircular stapler, can be positioned adjacent to a transected rectum13356. Moreover, the anvil 13301 of the surgical instrument 13300 can beengaged with a transected colon 13355. A robotic tool 133175 isconfigured to engage the anvil 13301 and apply the retracting forceF_(RC). It can be difficult to confirm the relative position of thesurgical instrument 13300 with the targeted tissue, for example, withthe staple line through the transected colon 13355. In certaininstances, information from the surgical hub 13320 and robotic surgicalsystem can facilitate the alignment. For example, as shown in FIG. 250 ,the center of the surgical instrument 13300 can be shown relative to thecenter of the targeted tissue 13318 on the display screen 13310 of thesurgical instrument 13300. In certain instances, and as shown in FIG.251 , sensors and a wireless transmitter on the surgical instrument13300 can be configured to convey positioning information to thesurgical hub 13320, for example.

A colorectal procedure, visibility limitations thereof, and an alignmenttool for a surgical hub are further described herein and in U.S.Provisional Patent Application Ser. No. 62/611,341, entitled INTERACTIVESURGICAL PLATFORM, filed Dec. 28, 2017, the disclosure of which isherein incorporated by reference in its entirety.

As mentioned above, the display 13310 on the handheld instrument 13300can also be configured to alert the clinician in certain scenarios. Forexample, the display 13310 in FIG. 250 includes an alert 13318 becausethe one or more of the forces exceed the predefined force thresholds.Referring again to FIGS. 251 and 252 , during the colon resection, therobotic arm can exert a first force F_(RC) on the anvil, and thehandheld instrument 13300 can exert a second force F_(RR) on the rectum13356. The tension on the rectum 13356 by the circular stapler can becapped at a first limit (for example 0.5 lb in FIG. 252 ), and thetension on the colon 13355 from the robotic arm can be capped at asecond limit (for example 0.5 lb in FIG. 252 ). An intervention may besuggested to the clinician when the tension on the rectum 13356 or colon13355 exceeds a threshold value.

The tension on the colon F_(RC) in FIGS. 251 and 252 can be ascertainedby resistance to the robotic arm, and thus, can be determined by acontrol unit (e.g. the control unit 13114 of the robotic surgical system13110). Such information can be communicated to the handheld surgicalinstrument 13300 and displayed on the display 13310 thereof in thesterile field such that the information is readily available to theappropriate clinician in real-time, or near real-time, or any suitableinterval, rate, and/or schedule, for example.

In various instances, a surgical system, such as a surgical system 13360of FIGS. 253 and 254 , includes interactive secondary displays 13362,13364 within the sterile field. The interactive secondary displays13362, 13364 are also mobile control modules in certain instances andcan be similar to the interactive secondary displays 13130 in FIG. 248 ,for example. A surgeon's command console, or remote control module,13370, is the primary control module and can be positioned outside thesterile field. In one instance, the interactive secondary display 13362can be a mobile device, a watch, and/or a small tablet, which can beworn on the wrist and/or forearm of the user, and the interactivesecondary display 13364 can be a handheld mobile electronic device, suchas an iPad® tablet, which can be placed on a patient 13361 or thepatient's table during a surgical procedure. For example, theinteractive secondary displays 13362, 13364 can be placed on the abdomenor leg of the patient 13361 during the surgical procedure. In otherinstances, the interactive secondary displays 13362, 13364 can beincorporated into a handheld surgical instrument 13366 within thesterile field.

In one instance, the surgical system 13360 is shown during a surgicalprocedure. For example, the surgical procedure can be the colonresection procedure described herein with respect to FIGS. 249-252 . Insuch instances, the surgical system 13360 includes a robot 13372 and arobotic tool 13374 extending into the surgical site. The robotic toolcan be an ultrasonic device comprising an ultrasonic blade and a clamparm, for example. The surgical system 13360 also includes the remotecommand console 13370 that encompasses a robotic hub 13380. The controlunit for the robot 13372 is housed in the robotic hub 13380. A surgeon13371 is initially positioned at the remote command console 13370. Anassistant 13367 holds the handheld surgical instrument 13366, a circularstapler that extends into the surgical site. The assistant 13367 alsoholds a secondary display 13364 that communicates with the robotic hub13380. The secondary display 13364 is a mobile digital electronicdevice, which can be secured to the assistant's forearm, for example.The handheld surgical instrument 13366 includes a wireless communicationmodule. A second surgical hub 13382 is also stationed in the operatingroom. The surgical hub 13382 includes a generator module and can includeadditional modules as further described herein and in U.S. ProvisionalPatent Application Ser. No. 62/611,341, entitled INTERACTIVE SURGICALPLATFORM, filed Dec. 28, 2017, the disclosure of which is hereinincorporated by reference in its entirety.

Referring primarily to FIG. 253 , hubs 13380, 13382 include wirelesscommunication modules such that a wireless communication link isestablished between the two hubs 13380, 13382. Additionally, the robotichub 13380 is in signal communication with the interactive secondarydisplays 13362, 13364 within the sterile field. The hub 13382 is insignal communication with the handheld surgical instrument 13366. If thesurgeon 13371 moves over towards the patient 13361 and within thesterile field (as indicated by the reference character 13371′), thesurgeon 13371 can use one of the wireless interactive displays 13362,13364 to operate the robot 13372 away from the remote command console13370. The plurality of secondary displays 13362, 13364 within thesterile field allows the surgeon 13371 to move away from the remotecommand console 13370 without losing sight of important information forthe surgical procedure and controls for the robotic tools utilizedtherein.

The interactive secondary displays 13362, 13364 permit the clinician tostep away from the remote command console 13370 and into the sterilefield while maintaining control of the robot 13372. For example, theinteractive secondary displays 13362, 13364 allow the clinician tomaintain cooperative and/or coordinated control over the poweredhandheld surgical instrument(s) 13366 and the robotic surgical system atthe same time. In various instances, information is communicated betweenthe robotic surgical system, one or more powered handheld surgicalinstruments 13366, surgical hubs 13380, 13382, and the interactivesecondary displays 13362, 13364. Such information may include, forexample, the images on the display of the robotic surgical system and/orthe powered handheld surgical instruments, a parameter of the roboticsurgical system and/or the powered handheld surgical instruments, and/ora control command for the robotic surgical system and/or the poweredhandheld surgical instruments.

In various instances, the control unit of the robotic surgical system(e.g. the control unit 13113 of the robotic surgical system 13110) isconfigured to communicate at least one display element from thesurgeon's command console (e.g. the console 13116) to an interactivesecondary display (e.g. the display 13130). In other words, a portion ofthe display at the surgeon's console is replicated on the display of theinteractive secondary display, integrating the robot display with theinteractive secondary display. The replication of the robot display onto the display of the interactive secondary display allows the clinicianto step away from the remote command console without losing the visualimage that is displayed there. For example, at least one of theinteractive secondary displays 13362, 13364 can display information fromthe robot, such as information from the robot display and/or thesurgeon's command console 13370.

In various instances, the interactive secondary displays 13362, 13364are configured to control and/or adjust at least one operating parameterof the robotic surgical system. Such control can occur automaticallyand/or in response to a clinician input. Interacting with atouch-sensitive screen and/or buttons on the interactive secondarydisplay(s) 13362, 13364, the clinician is able to input a command tocontrol movement and/or functionality of the one or more robotic tools.For example, when utilizing a handheld surgical instrument 13366, theclinician may want to move the robotic tool 13374 to a differentposition. To control the robotic tool 13374, the clinician applies aninput to the interactive secondary display(s) 13362, 13364, and therespective interactive secondary display(s) 13362, 13364 communicatesthe clinician input to the control unit of the robotic surgical systemin the robotic hub 13380.

In various instances, a clinician positioned at the remote commandconsole 13370 of the robotic surgical system can manually override anyrobot command initiated by a clinician input on the one or moreinteractive secondary displays 13362, 13364. For example, when aclinician input is received from the one or more interactive secondarydisplays 13362, 13364, a clinician positioned at the remote commandconsole 13370 can either allow the command to be issued and the desiredfunction performed or the clinician can override the command byinteracting with the remote command console 13370 and prohibiting thecommand from being issued.

In certain instances, a clinician within the sterile field can berequired to request permission to control the robot 13372 and/or therobotic tool 13374 mounted thereto. The surgeon 13371 at the remotecommand console 13370 can grant or deny the clinician's request. Forexample, the surgeon can receive a pop-up or other notificationindicating the permission is being requested by another clinicianoperating a handheld surgical instrument and/or interacting with aninteractive secondary display 13362, 13364.

In various instances, the processor of a robotic surgical system, suchas the robotic surgical systems 13000 (FIG. 239 ), 13400 (FIG. 240 ),13150 (FIG. 246 ), 13100 (FIG. 248 ), and/or the surgical hub 13380,13382, for example, is programmed with pre-approved functions of therobotic surgical system. For example, if a clinician input from theinteractive secondary display 13362, 13364 corresponds to a pre-approvedfunction, the robotic surgical system allows for the interactivesecondary display 13362, 13364 to control the robotic surgical systemand/or does not prohibit the interactive secondary display 13362, 13364from controlling the robotic surgical system. If a clinician input fromthe interactive secondary display 13362, 13364 does not correspond to apre-approved function, the interactive secondary display 13362, 13364 isunable to command the robotic surgical system to perform the desiredfunction. In one instances, a situational awareness module in therobotic hub 13370 and/or the surgical hub 13382 is configured to dictateand/or influence when the interactive secondary display can issuecontrol motions to the robot surgical system.

In various instances, an interactive secondary display 13362, 13364 hascontrol over a portion of the robotic surgical system upon makingcontact with the portion of the robotic surgical system. For example,when the interactive secondary display 13362, 13364 is brought intocontact with the robotic tool 13374, control of the contacted robotictool 13374 is granted to the interactive secondary display 13362, 13364.A clinician can then utilize a touch-sensitive screen and/or buttons onthe interactive secondary display 13362, 13364 to input a command tocontrol movement and/or functionality of the contacted robotic tool13374. This control scheme allows for a clinician to reposition arobotic arm, reload a robotic tool, and/or otherwise reconfigure therobotic surgical system. In a similar manner as discussed above, theclinician 13371 positioned at the remote command console 13370 of therobotic surgical system can manually override any robot commandinitiated by the interactive secondary display 13362, 13364.

In one aspect, the robotic surgical system includes a processor and amemory communicatively coupled to the processor, as described herein.The memory stores instructions executable by the processor to receive afirst user input from a console and to receive a second user input froma mobile wireless control module for controlling a function of a roboticsurgical tool, as described herein.

In various aspects, the present disclosure provides a control circuit toreceive a first user input from a console and to receive a second userinput from a mobile wireless control module for controlling a functionof a robotic surgical tool, as described herein. In various aspects, thepresent disclosure provides a non-transitory computer readable mediumstoring computer readable instructions which, when executed, cause amachine to receive a first user input from a console and to receive asecond user input from a mobile wireless control module for controllinga function of a robotic surgical tool, as described herein.

A robotic surgical system may include multiple robotic arms that areconfigured to assist the clinician during a surgical procedure. Eachrobotic arm may be operable independently of the others. A lack ofcommunication may exist between each of the robotic arms as they areindependently operated, which may increase the risk of tissue trauma.For example, in a scenario where one robotic arm is configured to applya force that is stronger and in a different direction than a forceconfigured to be applied by a second robotic arm, tissue trauma canresult. For example, tissue trauma and/or tearing may occur when a firstrobotic arm applies a strong retracting force to the tissue while asecond robotic arm is configured to rigidly hold the tissue in place.

In various instances, one or more sensors are attached to each roboticarm of a robotic surgical system. The one or more sensors are configuredto sense a force applied to the surrounding tissue during the operationof the robotic arm. Such forces can include, for example, a holdingforce, a retracting force, and/or a dragging force. The sensor from eachrobotic arm is configured to communicate the magnitude and direction ofthe detected force to a control unit of the robotic surgical system. Thecontrol unit is configured to analyze the communicated forces and setlimits for maximum loads to avoid causing trauma to the tissue in asurgical site. For example, the control unit may minimize the holdingforce applied by a first robotic arm if the retracting or dragging forceapplied by a second robotic arm increases.

FIG. 255 depicts a robotic surgical system 13800 including a controlunit 13820 and a robot 13810. The robotic surgical system 13800 issimilar in many respects to the robotic surgical system 13000 includingthe robot 13002 (FIG. 239 ), for example. The control unit 13820includes a processor 13822 and a display 13824. The robot 13810 includestwo robotic arms, 13830, 13840 configured to carry out various surgicalfunctions. Each of the robotic arms 13830, 13840 are independentlyoperable and are free to move in a space defining a control envelope ofthe robotic surgical system 13800. The one or more robotic arms, 13830,13840, are configured to receive a tool, such as a stapler, a radiofrequency (RF) tool, an ultrasonic blade, graspers, and/or a cuttinginstrument, for example. Other suitable surgical tool can be used. Invarious instances, the robotic arms 13830, 13840 each include adifferent tool configured to perform different functions. In otherinstances, all of the robotic arms 13830, 13840 include the same tool,although any suitable arrangement can be used.

The first robotic arm 13830 includes a first driver 13834 and a firstmotor 13836. When activated by the processor 13822, the first motor13836 drives the first driver 13834 actuating the correspondingcomponent of the first robotic arm 13830. The second robotic arm 13840includes a second driver, 13844 and a second motor 13846. When activatedby the processor 13822, the second motor 13846 drives the second driver13844 actuating the corresponding component of the second robotic arm13840.

Each of the robotic arms 13830, 13840, includes a sensor 13832, 13842 insignal communication with the processor 13822 of the control unit 13820.The sensors 13832, 13842 can be positioned on the drivers 13834, 13844,respectively, and/or on the motors 13836, 13846, respectively. Invarious instances, the sensors 13832, 13842 are configured to detect thelocation of each individual robotic arm 13830, 13840 within the controlenvelope of the robotic surgical system 13800. The sensors 13832, 13842are configured to communicate the detected locations to the processor13822 of the robotic surgical system 13800. In various instances, thepositions of the robotic arms 13830, 13840 are displayed on the display13824 of the control unit 13820. As described in more detail below, invarious instances, the processor 13822 is configured to run an algorithmto implement position limits specific to each robotic arm 13830, 13840in an effort to avoid tissue trauma and damage to the robotic surgicalsystem 13800, for example. Such position limits may increase theclinician's ability to cooperatively operate numerous robotic arms13830, 13840 of the robotic surgical system 13800 at the same time.

In various instances, the sensors 13832, 13842 are configured to detectthe force exerted by each robotic arm 13830, 13840. The sensors 13832,13842 can be torque sensors. As stated above, each robotic arm 13830,13840 of the robotic surgical system 13800 is independently operable.During a particular surgical procedure, a clinician may want to performdifferent surgical functions with each robotic arm 13830, 13840. Upondetecting the exerted forces of each robotic arm 13830, 13840, eachsensor 13832, 13842 is configured to communicate the detected forces tothe processor 13822. The processor 13822 is then configured to analyzethe communicated information and set maximum and/or minimum force limitsfor each robotic arm 13830, 13840 to reduce the risk of causing tissuetrauma, for example. In addition, the processor 13822 is configured tocontinuously monitor the exerted forces by each robotic arm 13830, 13840and, based on the direction and magnitude of the exerted forces,proportionally control each robotic arm 13830, 13840 with respect to oneanother. For example, the opposing force between two robotic arms 13830,13840 can be measured and maintained below a maximum force limit. Tomaintain the opposing force below a maximum force limit, at least one ofthe forces can be reduced, which can result in displacement of therobotic arm 13830, 13840.

By way of example, FIG. 256 depicts a surgical site and a portion of thesurgical system 13800, which includes three robotic arms, including arobotic arm 13850 (a third robotic arm) in addition to the robotic arms13830 and 13840, which are also schematically depicted in FIG. 255 . Thefirst robotic arm 13830 is configured to hold a portion of stomachconnective tissue. In order to hold the portion of stomach connectivetissue, the first robotic arm 13830 exerts an upward force F_(H1). Thesecond robotic arm 13840 applies a dragging and/or cutting force F_(D2)to the tissue. Simultaneously, the third robotic arm 13850 retracts aportion of liver tissue away from the current surgical cut location,further exposing the next surgical cut location. In order to move theportion of liver tissue out of the way of the advancing second roboticarm 13840, the third robotic arm 13850 applies a retracting force F_(R3)away from the second robotic arm 13840. In various exemplifications, asthe second robotic arm 13840 advances further into the surgical site,the control unit of the robotic surgical system directs the thirdrobotic arm 13850 to increase the exerted retracting force F_(R3) tocontinue exposing the next surgical cut location. While FIG. 256 depictsa particular surgical procedure and specific robotic arms, any suitablesurgical procedure can be performed, and any suitable combination ofrobotic arms can utilize the control algorithms disclosed herein.

FIG. 257 depicts graphical representations 13852, 13854 of the forcesexerted by the robotic arms 13830, 13840, and 13850 of FIG. 256 and therelative locations of the robotic arm 13830, 13840, and 13850,respectively, from the particular surgical procedure detailed above. Thegraphical display 13852 in FIG. 257 represents the exerted forces ofeach robotic arm 13830, 13840, and 13850 over a period of time, whilethe graphical display 13854 represents the relative positions of eachrobotic arm 13830, 13840, and 13850 over the same period of time. Asdiscussed above, the first robotic arm 13830 is configured to exert aholding force F_(H1) on a portion of stomach connective tissue. Theholding force F_(H1) is represented by a solid line on the graphs 13852,13854. The second robotic arm 13840 is configured to exert a draggingand/or cutting force F_(D2) on the stomach connective tissue. Thedragging force F_(D2) is represented by a dash-dot line on the graphs13852, 13854. The third robotic arm 13850 is configured to exert aretracting force F_(R3) on a portion of liver tissue. The retractingforce F_(R3) is represented by a dotted line on the graphs 13852, 13854.

In various instances, the control unit of the robotic surgical systemimposes at least one force threshold, such as a maximum force threshold,as depicted in the graphical display 13852. Thus, the third robotic arm13850 is prevented from exerting a retraction force F_(R3) greater thanthe maximum retraction force threshold. Such maximum force limits areimposed in order to avoid tissue trauma and/or avoid damage to thevarious robotic arms 13830, 13840, and 13850, for example.

Additionally or alternatively, the control unit 13820 of the roboticsurgical system 13800 can impose least one force threshold, such as aminimum force threshold, as depicted in the graphical display 13852. Inthe depicted instance, the first robotic arm 13830 is prevented fromexerting a holding force F_(H1) less than the minimum holding forcethreshold. Such minimum force limits are imposed in order to avoidmaintain appropriate tissue tension and/or visibility of the surgicalsite, for example.

In various instances, the control unit 13820 of the robotic surgicalsystem 13800 imposes maximum force differentials detected betweenvarious robotic arms during a load control mode. In order to set maximumforce differentials, the control unit 13820 of the robotic surgicalsystem is configured to continuously monitor the difference in magnitudeand direction of opposing forces by the robotic arms. As stated above,the first robotic arm 13830 is configured to hold a portion of thestomach connective tissue by exerting a holding force F_(H1). The secondrobotic arm 13840 is configured to apply a dragging force F_(D2), whichopposes the holding force F_(H1) exerted by the first robotic arm 13830.In various instances, maximum force differentials prevent inadvertentoverloading and/or damaging an object caught between the robotic arms13830, 13840, and 13850. Such objects include, for example, surroundingtissue and/or surgical components like clasps, gastric bands, and/orsphincter reinforcing devices. F_(max opposing) represents the maximumforce differential set by the control unit 13820 in this particularexemplification.

As can be seen in the graphical display 13852, the holding force F_(H1)and the dragging force F_(D2) both increase in magnitude at thebeginning of the surgical procedure. Such an increase in magnitudes canindicate a pulling of the tissue. The holding force F_(H1) and thedragging force F_(D2) increase in opposite directions to a point wherethe difference between the opposing forces is equal to F_(max opposing).In the graphic display 13852, the slanted lines highlight the point intime when F_(max opposing) is reached. Upon reaching F_(max opposing),the processor 13822 instructs the first robotic arm 13830 to reduce theholding force F_(H1) and continues to allow the second robotic arm 13840to exert the dragging force F_(D2) at the same value, and may allow aclinician to increase the dragging force. In various instances, thevalue of F_(max opposing) is set by the processor 13822 based on variousvariables, such as the type of surgery and/or relevant patientdemographics. In various instances, F_(max opposing) is a default valuestored in a memory of the processor 13822.

The relative positions of the robotic arms 13830, 13840, and 13850within the surgical site are depicted in the graph display 13854 of FIG.257 . As the first robotic arm 13830 exerts a holding force F_(H1) onthe stomach connective tissue and the third robotic arm 13850 exerts aretracting force F_(R3) on the liver tissue, the surgical site becomesclear and allows the second robotic arm 13840 to exert a dragging and/orcutting force F_(D2) on the desired tissue. The second robotic arm 13840and the third robotic arm 13850 become farther away from the firstrobotic arm 13830 as the procedure progresses. When the forcedifferential F_(max opposing) is reached between the holding forceF_(H1) and the dragging force F_(D2), the first robotic arm 13830 ismoved closer towards the second robotic arm 13840, lessening the exertedholding force F_(H1) by the first robotic arm 13830. In one aspect, theprocessor 13822 can transition the first robotic arm 13830 from the loadcontrol mode into a position control mode such that the position of thefirst robotic arm 13830 is held constant. As depicted in the graphicalrepresentations of FIG. 257 , when the first robotic arm 13830 is heldin a constant position, the force control for the second robotic arm13840 can continue to displace the second robotic arm 13840.

In various instances, the control unit 13820 of the robotic surgicalsystem directs the first robotic arm 13830 to hold a specific positionuntil a pre-determined force threshold between the first robotic arm13830 and a second robotic arm 13840 is reached. When the pre-determinedforce threshold is reached, the first robotic arm 13830 is configured toautomatically move along with the second robotic arm 13840 in order tomaintain the pre-determined force threshold. The first robotic arm 13830stops moving (or may move at a different rate) when the detected forceof the second robotic arm 13840 no longer maintains the pre-determinedforce threshold.

In various instances, the control unit 13820 of the robotic surgicalsystem is configured to alternate between the position control mode andthe load control mode in response to detected conditions by the roboticarms 13830, 13840, and 13850. For example, when the first robotic arm13830 and the second robotic arm 13840 of the robotic surgical system13800 are freely moving throughout a surgical site, the control unit13820 may impose a maximum force that each arm 13830, 13840 can exert.In various instances, the first and second arms 13830, 13840 eachinclude a sensor configured to detect resistance. In other instances,the sensors can be positioned on a surgical tool, such as an intelligentsurgical stapler or jawed tool. A resistance can be encountered uponcontact with tissue and/or other surgical instruments. When suchresistance is detected, the control unit 13820 may activate the loadcontrol mode and lower the exerted forces by one and/or more than one ofthe robotic arms 13830, 13840 to, for example, reduce damage to thetissue. In various instances, the control unit 13820 may activate theposition control mode and move the one and/or more than one of therobotic arms 13830, 13840 to a position where such resistance is nolonger detected.

In one aspect, the processor 13822 of the control unit 13820 isconfigured to switch from the load control mode to the position controlmode upon movement of a surgical tool mounted to one of the robotic arms13830, 13840 outside a defined surgical space. For example, if one ofthe robotic arms 13830, 13840 moves out of a defined boundary around thesurgical site, or into abutting contact with an organ or other tissue,or too close to another surgical device, the processor 13822 can switchto a position control mode and prevent further movement of the roboticarm 13830, 13840 and/or move the robotic arm 13830, 13840 back withinthe defined surgical space.

Turning now to the flow chart shown in FIG. 258 , an algorithm 13500 isinitiated at step 13501 when the clinician and/or the robotic surgicalsystem activates one or more of the robotic arms at step 13505. Thealgorithm 13500 can be employed by the robotic surgical system 13800 inFIG. 255 , for example. Each robotic arm is in signal communication withthe processor 13822 of the robotic surgical system. Followingactivation, each robotic arm is configured to send information to theprocessor. In various instances, the information may include, forexample, identification of the tool attachment and/or the initialposition of the activated robotic arm. In various instances, suchinformation is communicated automatically upon attachment of the tool tothe robotic arm, upon activation of the robotic arm by the roboticsurgical system, and/or after interrogation of the robotic arm by theprocessor, although the information may be sent at any suitable time.Furthermore, the information may be sent automatically and/or inresponse to an interrogation signal.

Based on the information gathered from each of the activated roboticarms at step 13510, the processor is configured to set a position limitfor each specific robotic arm within a work envelope of the roboticsurgical system at step 13515. The position limit can setthree-dimensional boundaries for where each robotic arm can travel. Thesetting of position limits allows for efficient and cooperative usage ofeach activated robotic arm while, for example, preventing trauma tosurrounding tissue and/or collisions between activated robotic arms. Invarious instances, the processor includes a memory including a set ofstored data to assist in defining each position limit. The stored datacan be specific to the particular surgical procedure, the robotic toolattachment, and/or relevant patient demographics, for example. Invarious instances, the clinician can assist in the definition of theposition limit for each activated robotic arm. The processor isconfigured to determine if the robotic arms are still activated at step13520. If the processor determines that the robotic arms are no longeractivated, the processor is configured to end position monitoring atstep 13522. Once the processor determines that the robotic arms arestill activated, the processor is configured to monitor the position ofeach activated robotic arm at step 13525.

The processor is then configured to evaluate whether the detectedposition is within the predefined position limit(s) at step 13530. Ininstances where information is unable to be gathered from the roboticarm and clinician input is absent, a default position limit is assignedat step 13533. Such a default position limit assigns a conservativethree-dimensional boundary to minimize, for example, tissue traumaand/or collisions between robotic arms. If the detected limit is withinthe position limit, the processor is configured to allow the roboticarm(s) to remain in position and/or freely move within the surgical siteat step 13535, and the monitoring process continues as long as therobotic arm is still activated. If the detected limit is outside of theposition limit, the processor is configured to move the robotic arm backinto the position limit at step 13532, and the monitoring processcontinues as long as the robotic arm is still activated.

The processor is configured to continuously monitor the position of eachrobotic arm at step 13525. In various instances, the processor isconfigured to repeatedly send interrogation signals in pre-determinedtime intervals. As discussed above, if the detected position exceeds theposition limit set for the specific robotic arm, in certain instances,the processor is configured to automatically move the robotic arm backwithin the three-dimensional boundary at step 13532. In certaininstances, the processor is configured to re-adjust the position limitsof the other robotic arms in response to one robotic arm exceeding itsoriginal position limit. In certain instances, prior to moving therobotic arm back within its position limit and/or adjusting the positionlimits of the other robotic arms, the processor is configured to alertthe clinician. If the detected position is within the position limit setfor the robotic arm, the processor permits the robotic arm to remain inthe same position and/or freely travel until the detected positionexceeds the position limit at step 13535. If the processor is unable todetect the position of the robotic arm, the processor is configured toalert the clinician and/or assign the robotic arm with the defaultposition limit at step 13533. The processor is configured to monitor theposition of each robotic arm until the surgery is completed and/or therobotic arm is deactivated.

Similar to the algorithm of FIG. 258 , the flow chart of FIG. 259depicts an algorithm 13600 that is initiated at step 13601 when aclinician and/or a robotic surgical system activates one or more of therobotic arms at step 13605. The algorithm 13600 can be employed by therobotic surgical system 13800 in FIG. 255 , for example. Each roboticarm is in signal communication with the processor. Following activation,each robotic arm is configured to send information to the processor atstep 13610. In various instances, the information may include, forexample, identification of the tool attachment, exerted forces detectedby one or more force sensors on the robotic arm, and/or the initialposition of the activated robotic arm. In various instances, suchinformation is communicated automatically upon attachment of the tool tothe robotic arm, upon activation of the robotic arm by the roboticsurgical system, and/or after interrogation of the robotic arm by theprocessor, although the information may be sent at any suitable time.Furthermore, the information may be sent automatically and/or inresponse to an interrogation signal.

Based on the information gathered from each of the activated roboticarms, the processor is configured to set a force limit for each specificrobotic arm at step 13615. The force limit sets maximum and minimumforce thresholds for forces exerted by each robotic arm. Additionally oralternatively, a force limit can be the maximum force differentialbetween two or more arms. The setting of force limits allows forefficient and cooperative usage of all of the activated robotic armswhile, for example, preventing trauma to surrounding tissue and/ordamage to the robotic arms. In various instances, the processor includesa memory including a set of stored data to assist in defining each forcelimit. The stored data can be specific to the particular surgicalprocedure, the robotic tool attachment, and/or relevant patientdemographics, for example. In various instances, the clinician canassist in the definition of the force limit for each activated roboticarm. In instances where information is unable to be gathered from therobotic arm and clinician input is absent, a default force limit isassigned. Such a default force limit assigns conservative maximum andminimum force thresholds to minimize, for example, tissue trauma and/ordamage to the robotic arms.

The processor is configured to determine if the robotic arm is active atstep at step 13620. If the processor determines that the robotic arm hasbeen deactivated, the processor is configured to end force monitoring atstep 13622. Once it has been determined that the robotic arm is stillactivated at step 13620, the processor is configured to continuouslymonitor the force exerted by each robotic arm at step 13625. In variousinstances, the processor is configured to repeatedly send interrogationsignals in pre-determined time intervals. If the detected force exceedsthe maximum force threshold set for the specific robotic arm, in certaininstances, the processor is configured to automatically decrease theforce exerted by the robotic arm and/or decrease an opposing forceexerted by another robotic arm at step 13632. In certain instances, theprocessor is configured to re-adjust the force limits assigned to theother robotic arms in response to one robotic arm exceeding its originalforce limits. In certain instances, prior to adjusting the force exertedby the robotic arm, adjusting the opposing force exerted by anotherrobotic arm, and/or adjusting the force limits of the other roboticarms, the processor is configured to alert the clinician. If thedetected force is within the force limit set for the robotic arm, therobotic arm is permitted to maintain the exertion of the force and/orthe clinician can increase or decrease the exerted force until the forceis out of the set force limit at step 13635. If the processor is unableto detect the exerted force of the robotic arm, the processor isconfigured to alert the clinician and/or assign the robotic arm with adefault force limit at step 13633. The processor is configured tomonitor the exerted force of each robotic arm until the surgery iscompleted and/or the robotic arm is deactivated at step 13620.

Similar to the algorithms of FIGS. 258 and 259 , the flow chart of FIG.260 depicts an algorithm 13700 that is initiated 13701 when a clinicianand/or a robotic surgical system activates one or more of the roboticarms 13705. The algorithm 13700 can be employed by the robotic surgicalsystem 13800 in FIG. 255 , for example. Each robotic arm is in signalcommunication with the processor. Following activation, each robotic armis configured to send information to the processor at step 13710. Invarious instances, the information may include, for example,identification of the tool attachment, forces detected by one or moreforce sensors on the robotic arm, and/or the initial position of theactivated robotic arm. In various instances, such information iscommunicated automatically upon attachment of the tool to the roboticarm, upon activation of the robotic arm by the robotic surgical system,and/or after interrogation of the robotic arm by the processor, althoughthe information may be sent at any suitable time. In various instances,the information is sent automatically and/or in response to aninterrogation signal.

Based on the information gathered from all of the activated roboticarms, the processor is configured to set both a position limit within awork envelope of the robotic surgical system and a force limit for eachspecific robotic arm at step 13715. The position limit setsthree-dimensional boundaries for where each robotic arm can travel. Thesetting of position limits allows for efficient and cooperative usage ofall of the activated robotic arms while, for example, preventing traumato surrounding tissue and/or collisions between activated robotic arms.The force limit sets maximum and/or minimum force thresholds for forcesexerted by each robotic arm. Additionally or alternatively, a forcelimit can be the maximum force differential between two or more arms.The setting of force limits allows for efficient and cooperative usageof the activated robotic arms while, for example, preventing trauma tosurrounding tissue and/or damage to the robotic arms.

In various instances, the processor includes a memory including a set ofstored data to assist in defining each position limit and force limit.The stored data can be specific to the particular surgical procedure,the robotic tool attachment, and/or relevant patient demographics, forexample. In various instances, the clinician can assist in thedefinition of the position limit and force limit for each activatedrobotic arm. In instances where information is unable to be gatheredfrom the robotic arm and clinician input is absent, a default positionlimit and/or default force limit is assigned to the robotic arm. Such adefault position limit assigns a conservative three-dimensional boundaryto minimize, for example, tissue trauma and/or collisions betweenrobotic arms, while the default force limit assigns conservative maximumand/or minimum force thresholds to minimize, for example, tissue traumaand/or damage to the robotic arms. In various instances, the processoris configured to adjust the position limit of one robotic arm based onthe force limit of another robotic arm, adjust the force limit of onerobotic arm based on the position limit of another robotic arm, and viceversa.

The processor is configured to determine whether the robotic arm isactive at step 13720. Once the processor has determined that the roboticarm is activated at step 13720, the processor is configured tocontinuously monitor the position of each arm 13737 and the forceexerted by each robotic arm at step 13725. If the robotic arm is nolonger activated, the processor is configured to end position monitoringat step 13727 and end force monitoring at step 13722. In variousinstances, the processor is configured to repeatedly send interrogationsignals in pre-determined time intervals. If the detected positionexceeds the position limit set for the specific robotic arm, in certaininstances, the processor is configured to automatically move the roboticarm back within the three-dimensional boundary at step 13742. In certaininstances, prior to moving the robotic arm back within its positionlimit, the processor is configured to alert the clinician. If thedetected position is within the position limit set for the robotic arm,the robotic arm is permitted to remain in the same position and/orfreely travel until the detected position exceeds the position limit atstep 13745. If the processor is unable to detect the position of therobotic arm, the processor is configured to alert the clinician and/orrewrite the original position limit of the robotic arm with the defaultposition limit at step 13743. The processor is configured to monitor theposition of each robotic arm until the surgery is completed and/or therobotic arm is deactivated.

In certain instances, the robotic surgical system includes a manualoverride configured to control the position of each robotic arm. If thedetected force exceeds the maximum force threshold set for the specificrobotic arm, in certain instances, the processor is configured toautomatically decrease the force exerted by the robotic arm and/ordecrease an opposing force exerted by another robotic arm at step 13732.In certain instances, prior to decreasing the force exerted by therobotic arm and/or decrease the opposing force exerted by anotherrobotic arm, the processor is configured to alert the clinician. If thedetected force is within the force limit set for the robotic arm, therobotic arm is permitted to maintain the exertion of the force and/orincrease or decrease the exerted force until the force is out of the setforce limit at step 13735. If the processor is unable to detect theexerted force of the robotic arm, the processor is configured to alertthe clinician and/or rewrite the original force limit of the robotic armwith the default force limit at step 13733. The processor is configuredto monitor the exerted force of each robotic arm until the surgery iscompleted and/or the robotic arm is deactivated.

In various instances, the position monitoring system and the forcemonitoring system are interconnected. In certain instances, the forcemonitoring system can override the resultant decision 13742, 14743,14745 of the position detection step 13740. In certain instances, theposition monitoring system can override the resultant decision 13732,13733, 13735 of the force detection step 13730. In other instances, theposition monitoring system and the force monitoring system areindependent of one another.

A clinician can manually override the automatic adjustments implementedin the automatic load and/or position control mode(s) described herein.The manual override can be a one-time adjustment to the surgical robot.In other instances, the manual override can be a setting that turns offthe automatic load and/or position mode for a specific surgical action,a specific duration, and/or a global override for the entire procedure.

In one aspect, the robotic surgical system includes a processor and amemory communicatively coupled to the processor, as described herein.The processor is communicatively coupled to a first force sensor and asecond force sensor, and the memory stores instructions executable bythe processor to affect cooperative movement of a first robotic arm anda second robotic arm based on a first input from the first force sensorand from a second input from the second force sensor in a load controlmode, as described herein.

In various aspects, the present disclosure provides a control circuit toaffect cooperative movement of a first robotic arm and a second roboticarm, as described herein. In various aspects, the present disclosureprovides a non-transitory computer readable medium storing computerreadable instructions which, when executed, cause a machine to affectcooperative movement of a first robotic arm and a second robotic arm, asdescribed herein.

During a particular surgical procedure, clinicians may rely on one ormore powered handheld surgical instruments in addition to a roboticsurgical system. In various instances, the instruments are controlledand monitored through different platforms, which may inhibitcommunication between the instruments and the robotic surgical system.For example, the instruments can be produced by different manufacturersand even by competitors. Such instruments may have differentcommunication packages and/or communication and/or linking protocols.The lack of communication between a powered instrument and the roboticsurgical system may hinder cooperative and/or coordinated usage and maycomplicate the surgical procedure for the clinician. For example, eachsurgical instrument may include an individual display to communicatevarious information and operating parameters. In such a scenario, aclinician may have to look at numerous instrument-specific displays tomonitor the operating status of and analyze data gathered by eachdevice.

In various instances, a robotic surgical system is configured to detectthe presence of other powered surgical instruments that are controlledby platforms other than the robotic surgical system. The roboticsurgical system can incorporate a hub, i.e., a robotic hub like therobotic hubs 122 (FIG. 2 ) and 222 (FIG. 9 ), which can detect otherpowered surgical instruments, for example. In other instances, astand-alone surgical hub like the hub 106 (FIGS. 1-3 ) or the hub 206(FIG. 9 ) in communication with the robotic surgical system canfacilitate detection of the non-robotic surgical instruments andcooperative and/or coordinated usage of the detected surgicalinstruments with the robotic surgical system. The hub, which can be arobotic hub or a surgical hub, is configured to display the position andorientation of the powered surgical instruments with respect to the workenvelope of the robotic surgical system. In certain instances, the workenvelope can be an operating room, for example. A surgical hub havingspatial awareness capabilities is further described herein and in U.S.Provisional Patent Application Ser. No. 62/611,341, entitled INTERACTIVESURGICAL PLATFORM, filed Dec. 28, 2017, the disclosure of which isherein incorporated by reference in its entirety. In one aspect, the hubcan first ascertain the boundaries of the work envelope and then detectthe presence of other powered surgical instruments within the workenvelope.

FIG. 261 depicts a surgical system 13860 including a robotic surgicalsystem 13865, a surgical instrument 13890, and a surgical hub 13870. Thesurgical instrument 13890 is a powered handheld instrument, and can be amotorized surgical stapler, such as the motorized linear staplerdepicted in FIG. 262 , for example. The surgical system 13865 can besimilar in many respects to the robotic surgical system 13000 (FIG. 239), for example. As described herein, the surgical hub 13870 can beincorporated into the robotic surgical system 13865, for example. Thesurgical hub 13870 is configured to be in signal communication with therobotic surgical system 13865 and the surgical instrument 13890. Inother instances, the surgical system 13860 can include additionalhandheld surgical instruments. The robotic surgical system 13865includes a robot 13861, which can be similar to the robot 13002, forexample. The robotic surgical system 13865 also includes a control unit13862 and a surgeon's command console, or remote control module, 13864.The surgeon's command console 13864 is configured to receive a clinicianinput. The control unit 13862 includes a robot display 13868 and aprocessor 13866. The surgical instrument 13890 includes a display 13894and a processor 13892.

In various instances, the surgical hub 13870 includes a surgical hubdisplay 13880, which can be similar to the displays of the visualizationsystem 108 (FIG. 1 ). The surgical hub display 13880 can include, forexample, a heads up display. The surgical hub 13880 is configured todetect the presence of the surgical instrument 13890 within a certaindistance of the surgical hub 13870. For example, the surgical hub 13870is configured to detect the presence of all activated surgicalinstruments 13890 within one operating room, although any suitabledistance can be monitored. In various instances, the surgical hub 13870is configured to display the presence of all activated surgicalinstruments 13890 on the surgical hub display 13880.

A particular handheld surgical instrument communicates via a firstcommunication process through a first language. A particular roboticsurgical system communicates via a second communication process througha second language. In various instances, the first communication processis the same as the second communication process. When the firstcommunication process is the same as the second communication process,the surgical instrument 13890 is configured to directly communicateinformation to the surgical hub 13870 and/or to the robotic surgicalsystem 13865. Such information includes, for example, a model numberand/or type of the surgical instrument, a position of the surgicalinstrument, an operating status of the surgical instrument, and/or anyother relevant parameter of the surgical instrument.

In various instances, the first communication process is different fromthe second communication process. For example, a surgical system (e.g. arobot) developed by a first manufacturer may utilize a first proprietarylanguage or communication scheme and a surgical system (e.g. a handheldsurgical tool) developed by a second manufacturer may utilize a second,different proprietary language or communication scheme. Despite thelanguage difference/barrier, the surgical hub 13870 and/or surgicalrobot 13865 is configured to sense surgical instruments 13890 thatoperate on different communication processes. When the surgical hub13870 does not recognize the communication process utilized by aparticular powered handheld surgical instrument, the surgical hub 13870is configured to detect various signals, such as Wi-Fi and Bluetoothtransmissions emitted by activated powered handheld surgicalinstruments. Based on the detected signal transmissions, the surgicalhub 13870 is configured to alert the clinician of all powered handheldsurgical instruments that do not use the same communication process asthe robotic surgical system 13865. All data received from newly-detectedpowered handheld surgical instruments can be stored within the surgicalhub 13870 so that the newly-detected powered handheld surgicalinstruments are recognized by the surgical hub 13870 in the future.

In various instances, the surgical hub 13870 is configured to detect thepresence of powered handheld surgical instruments by sensing a magneticpresence of a battery, power usage, and/or electro-magnetic fieldemitted from activated powered handheld surgical instruments, regardlessof whether the activated powered handheld surgical instruments made anyattempt to communicate with another surgical instrument, such as therobotic surgical system.

The robot 13861 and the surgical instrument 13890 are exemplified in anexample surgical procedure in FIG. 262 . In this exemplification, thesurgical instrument 13890 is an articulating linear stapler. As depictedin FIG. 262 , the surgical instrument 13890 includes a motor 13895 inthe handle 13892 thereof. In other instances, the surgical instrument13890 can include a plurality of motors positioned throughout thesurgical instrument. The motor 13895 is configured to emit anelectromagnetic field 13896, which can be detected by the roboticsurgical system 13865 or the surgical hub 13870. For example, the mainrobot tower or the modular control tower of the surgical hub 13870 caninclude a receiver for detecting the electromagnetic fields within theoperating room.

In one aspect, a processor of the robotic surgical system (e.g. aprocessor of the control unit 13862) is configured to calculate aboundary around the surgical instrument 13890. For example, based on theelectromagnetic field 13896 and corresponding type of surgicalinstrument, the processor can determine the dimensions of the surgicalinstrument 13890 and possible range of positions thereof. For example,when the surgical instrument 13890 includes one or more articulationjoints 13891, the range of positions can encompass the articulatedpositions of the surgical instrument 13890.

In one instance, the robotic surgical system can calculate a first widerboundary B₂ around the surgical instrument. When a robotic surgical toolapproaches the wider boundary B₂, the robotic surgical tool 13861 canissue a notification or warning to the surgeon that the robotic surgicaltool attached to the robot 13861 is approaching another surgicalinstrument 13890. In certain instances, if the surgeon continues toadvance the robotic surgical tool toward the surgical instrument 13890and to a second narrower boundary B₁, the robotic surgical system 13865can stop advancing the robotic surgical tool. For example, if therobotic surgical tool crosses the narrower boundary B₁, advancement ofthe robotic surgical tool can be stopped. In such instances, if thesurgeon still desires to continue advancing the robotic surgical toolwithin the narrower boundary B₁, the surgeon can override the hard stopfeature of the robotic surgical system 13865.

Referring again to FIG. 261 , the surgical system 13860 includesmultiple display monitors. Each handheld surgical instrument 13890 andthe robotic surgical system 13865 is configured to communicate a videoand/or image feed representative of the display on each device to thesurgical hub 13870 and/or the hub display 13880. Such video and/or imagefeeds can include operating parameters of and/or detected conditions byeach handheld surgical instrument 13890 and/or the robotic surgicalsystem 13865. The hub 13870 is configured to control the displayed videoand/or image feeds on each of the one or more display monitorsthroughout the system 13800. In various instances, each of the displaymonitors displays an individual video and/or image feed from aparticular surgical device or system. In various instances, theindividual video and/or image feed can be overlaid with additionalinformation and/or video and/or image feeds from other devices orsystems. Such information can include operating parameters and/ordetected conditions. The surgical hub 13870 is configured to requestwhich display monitor displays which video and/or image feed. In otherwords, the communication link between the surgical hub 13870 and the hubdisplay 13880 allows the surgical hub 13870 to dictate which videoand/or image feed is assigned to which display monitor, while directcontrol of the one or more display monitors remains with the video hub.In various instances, the hub display 13880 is configured to separateone or more of the display monitors from the surgical hub 13870 andallow a different surgical hub or surgical device to display relevantinformation on the separated display monitors.

In various instances, the surgical hub is configured to communicatestored data with other data systems within an institution data barrierallowing for cooperative utilization of data. Such established datasystems may include, for example, an electronic medical records (EMR)database. The surgical hub is configured to utilize the communicationbetween the surgical hub and the EMR database to link overall surgicaltrends for the hospital with local data sets recorded during use of thesurgical hub.

In various instances, the surgical hub is located in a particularoperating room at a hospital and/or surgery center. As shown in FIG. 263, the hospital and/or surgery center includes operating rooms, OR₁, OR₂,OR₃, and OR₄. Three of the operating rooms OR₂, OR₃, and OR₄ shown inFIG. 263 includes a surgical hub 13910, 13920, 13930, respectively,however any suitable number of surgical hubs can be used. Each surgicalhub 13910, 13920, 13930 is configured to be in signal communication withone another, represented by signal arrows A. Each surgical hub 13910,13920, 13930 is also configured to be in signal communication with aprimary server 13940, represented by signal arrows B in FIG. 263 .

In various exemplifications, as data is communicated between thesurgical hub(s) 13910, 13920, 13930 and the various surgical instrumentsduring a surgical procedure, the surgical hub(s) 13910, 13920, 13930 areconfigured to temporarily store the communicated data. At the end of thesurgical procedure and/or at the end of a pre-determined time period,each surgical hub 13910, 13920, 13930 is configured to communicate thestored information to the primary server 13940. Once the storedinformation is communicated to the primary server 13940, the informationcan be deleted from the memory of the individual surgical hub 13910,13920, 13930. The stored information is communicated to the primaryserver 13940 to alleviate the competition amongst the surgical hubs13910, 13920, 13930 for bandwidth to transmit the stored data to cloudanalytics “C”, for example. Instead, the primary server 13940 isconfigured to compile and store and communicated data. The primaryserver 13940 is configured to be the single clearinghouse forcommunication of information back to the individual surgical hubs 13910,13920, 13930 and/or for external downloading. In addition, as all of thedata is stored in one location in the primary server 13940, the data isbetter protected from data destructive events, such as power surgesand/or data intrusion, for example. In various instances, the primaryserver 13940 includes additional server-level equipment that allows forbetter data integrity. Examples of cloud systems are further describedherein and in U.S. Provisional Patent Application Ser. No. 62/611,340,entitled CLOUD-BASED MEDICAL ANALYTICS, filed Dec. 28, 2017, thedisclosure of which is herein incorporated by reference in its entirety.

Referring to FIGS. 263 and 264 , as data begins to be communicated fromeach control hub 13910, 13920, 13930 to the primary server 13940, aqueue 13990 is created to prioritize the order in which data iscommunicated. In various instances, the queue 13990 prioritizes data asfirst in, first out, although any suitable prioritization protocol canbe used. In various instances, the queue 13990 is configured tore-prioritize the order in which received data is communicated whenpriority events and/or abnormal data are detected. As illustrated inFIG. 264 , a first surgical hub communicates a first set of data at atime t=1 at block 13960. As the first set of data is the only data inthe queue for external output at block 13992, the first set of data isthe first to be communicated. Thus, the queue 13990 prioritizes thefirst set of data for external output at block 13965. A second surgicalhub communicates a second set of data at a time t=2 at block 13970. Atthe time t=2, the first set of data has not been externally communicatedat block 13994. However, because no priority events and/or abnormal dataare present in the second set of data, the second set of data is thesecond in line to be externally communicated at block 13975. A thirdsurgical hub communicates a third set of data flagged as urgent at atime t=3 at block 13980. At the time t=3, the first set of data and thesecond set of data have not been externally communicated, however apriority event has been detected in the third set of data at block13985. The queue is configured to re-prioritize the sets of data toallow the prioritized third set of data to be in the first position forexternal output at block 13996 above the first set of data and thesecond set of data collected at time t=1 and t=2, respectively.

In one aspect, the surgical hub includes a processor and a memorycommunicatively coupled to the processor, as described herein. Thememory stores instructions executable by the processor to detect thepresence of a powered surgical instrument and represent the poweredsurgical instrument on a hub display, as described herein.

In various aspects, the present disclosure provides a control circuit todetect the presence of a powered surgical instrument and represent thepowered surgical instrument on a hub display, as described herein. Invarious aspects, the present disclosure provides a non-transitorycomputer readable medium storing computer readable instructions which,when executed, cause a machine to detect the presence of a poweredsurgical instrument and represent the powered surgical instrument on ahub display, as described herein.

Another robotic surgical system is the VERSIUS® robotic surgical systemby Cambridge Medical Robots Ltd. of Cambridge, England. An example ofsuch a system is depicted in FIG. 265 . Referring to FIG. 265 , thesurgical robot includes an arm 14400 which extends from a base 14401.The arm 14400 includes a number of rigid limbs 14402 that are coupledtogether by revolute joints 14403. The most proximal limb 14402 a iscoupled to the base 14401 by a joint 14403 a. The most proximal limb14402 a and the other limbs (e.g. limbs 14402 b and 14402 c) are coupledin series to further limbs at the joints 14403. A wrist 14404 can bemade up of four individual revolute joints. The wrist 14404 couples onelimb (e.g. limb 14402 b) to the most distal limb (e.g. the limb 14402 cin FIG. 265 ) of the arm 14400. The most distal limb 14402 c carries anattachment 14405 for a surgical tool 14406. Each joint 14403 of the arm14400 has one or more motors 14407, which can be operated to causerotational motion at the respective joint, and one or more positionand/or torque sensors 14408, which provide information regarding thecurrent configuration and/or load at that joint 14403. The motors 14407can be arranged proximally of the joints 14403 whose motion they drive,so as to improve weight distribution, for example. For clarity, onlysome of the motors and sensors are shown in FIG. 265 . The arm 14400 maybe generally as described in Patent Application PCT/GB2014/053523 andInternational Patent Application Publication No. WO 2015/025140,entitled DISTRIBUTOR APPARATUS WITH A PAIR OF INTERMESHING SCREW ROTORS,filed Aug. 18, 2014, which published on Feb. 26, 2015, and which isherein incorporated by reference in its entirety. Torque sensing isfurther described in U.S. Patent Application Publication No.2016/0331482, entitled TORQUE SENSING IN A SURGICAL ROBOTIC WRIST, filedMay 13, 2016, which published on Nov. 17, 2016, which is hereinincorporated by reference in its entirety.

The arm 14400 terminates in the attachment 14405 for interfacing withthe surgical tool 14406. The attachment 14405 includes a drive assemblyfor driving articulation of the surgical tool 14406. Movable interfaceelements of a drive assembly interface mechanically to engagecorresponding movable interface elements of the tool interface in orderto transfer drive motions from the robot arm 14400 to the surgical tool14406. One surgical tool may be exchanged for another surgical tool oneor more times during a typical operation. The surgical tool 14406 can beattachable and detachable from the robot arm 14400 during the operation.Features of the drive assembly interface and the tool interface can aidin their alignment when brought into engagement with each other, so asto reduce the accuracy with which they need to be aligned by the user. Abar for guiding engagement of a robotic arm and surgical tool is furtherdescribed in U.S. Patent Application Publication No. 2017/0165012,entitled GUIDING ENGAGEMENT OF A ROBOT ARM AND SURGICAL INSTRUMENT,filed Dec. 9, 2016, which published on Jun. 15, 2017, which is hereinincorporated by reference in its entirety.

The surgical tool 14406 further includes an end effector for performingan operation. The end effector may take any suitable form. For example,the end effector may include smooth jaws, serrated jaws, a gripper, apair of shears, a needle for suturing, a camera, a laser, a knife, astapler, one or more electrodes, an ultrasonic blade, a cauterizer,and/or a suctioner. Alternative end effectors are further describedherein. The surgical tool 14406 can include an articulation junctionbetween the shaft and the end effector, which can permit the endeffector to move relative to the shaft of the tool. The joints in thearticulation junction can be actuated by driving elements, such aspulley cables. Pulley arrangements for articulating the surgical tool14406 are described in U.S. Patent Application Publication No.2017/0172553, entitled PULLEY ARRANGEMENT FOR ARTICULATING A SURGICALINSTRUMENT, filed Dec. 9, 2016, which published on Jun. 22, 2017, whichis herein incorporated by reference in its entirety. The drivingelements for articulating the surgical tool 14406 are secured to theinterface elements of the tool interface. Thus, the robot arm 14400 cantransfer drive motions to the end effector as follows: movement of adrive assembly interface element moves a tool interface element, whichmoves a driving element in the tool 14406, which moves a joint of thearticulation junction, which moves the end effector. Control of arobotic arm and tool, such as the arm 14400 and the tool 14406, arefurther described in U.S. Patent Application Publication No.2016/0331482, entitled TORQUE SENSING IN A SURGICAL ROBOTIC WRIST, filedMay 13, 2016 and which was published on Nov. 17, 2016, and inInternational Patent Application Publication No. WO 2016/116753,entitled ROBOT TOOL RETRACTION, filed Jan. 21, 2016 and which waspublished on Jul. 28, 2016, each of which is herein incorporated byreference in its entirety.

Controllers for the motors 14407 and the sensors 14408 (e.g. torquesensors and encoders) are distributed within the robot arm 14400. Thecontrollers are connected via a communication bus to a control unit14409. Examples of communication paths in a robotic arm, such as the arm14400, are further described in U.S. Patent Application Publication No.2017/0021507, entitled DRIVE MECHANISMS FOR ROBOT ARMS and in U.S.Patent Application Publication No. 2017/0021508, entitled GEAR PACKAGINGFOR ROBOTIC ARMS, each of which was filed Jul. 22, 2016 and published onJan. 26, 2017, and each of which is herein incorporated by reference inits entirety. The control unit 14409 includes a processor 14410 and amemory 14411. The memory 14411 can store software in a non-transient waythat is executable by the processor 14410 to control the operation ofthe motors 14407 to cause the arm 14400 to operate in the mannerdescribed herein. In particular, the software can control the processor14410 to cause the motors 14407 (for example via distributedcontrollers) to drive in dependence on inputs from the sensors 14408 andfrom a surgeon command interface 14412.

The control unit 14409 is coupled to the motors 14407 for driving themin accordance with outputs generated by execution of the software. Thecontrol unit 14409 is coupled to the sensors 14408 for receiving sensedinput from the sensors 14408, and to the command interface 14412 forreceiving input from it. The respective couplings may, for example, eachbe electrical or optical cables, and/or may be provided by a wirelessconnection. The command interface 14412 includes one or more inputdevices whereby a user can request motion of the end effector in adesired way. The input devices could, for example, be manually operablemechanical input devices such as control handles or joysticks, orcontactless input devices such as optical gesture sensors. The softwarestored in the memory 14411 is configured to respond to those inputs andcause the joints of the arm 14400 and the tool 14406 to moveaccordingly, in compliance with a pre-determined control strategy. Thecontrol strategy may include safety features which moderate the motionof the arm 144400 and the tool 14406 in response to command inputs. Insummary, a surgeon at the command interface 14412 can control thesurgical tool 14406 to move in such a way as to perform a desiredsurgical procedure. The control unit 14409 and/or the command interface14412 may be remote from the arm 14400.

Additional features and operations of a surgical robot system, such asthe robotic surgical system depicted in FIG. 265 , are further describedin the following references, each of which is herein incorporated byreference in its entirety:

-   -   International Patent Application Publication No. WO 2016/116753,        entitled ROBOT TOOL RETRACTION, filed Jan. 21, 2016, which        published on Jul. 28, 2016;    -   U.S. Patent Application Publication No. 2016/0331482, entitled        TORQUE SENSING IN A SURGICAL ROBOTIC WRIST, filed May 13, 2016,        which published on Nov. 17, 2016;    -   U.S. Patent Application Publication No. 2017/0021507, entitled        DRIVE MECHANISMS FOR ROBOT ARMS, filed Jul. 22, 2016, which        published on Jan. 27, 2017;    -   U.S. Patent Application Publication No. 2017/0021508, entitled        GEAR PACKAGING FOR ROBOTIC ARMS, filed Jul. 22, 2016, which        published on Jan. 27, 2017;    -   U.S. Patent Application Publication No. 2017/0165012, entitled        GUIDING ENGAGEMENT OF A ROBOT ARM AND SURGICAL INSTRUMENT, filed        Dec. 9, 2016, which published on Jun. 15, 2017; and    -   U.S. Patent Application Publication No. 2017/0172553, entitled        PULLEY ARRANGEMENT FOR ARTICULATING A SURGICAL INSTRUMENT, filed        Dec. 9, 2016, which published on Jun. 22, 2017.

In one instance, the robotic surgical systems and features disclosedherein can be employed with the VERSIUS® robotic surgical system and/orthe robotic surgical system of FIG. 265 . The reader will furtherappreciate that various systems and/or features disclosed herein canalso be employed with alternative surgical systems including thecomputer-implemented interactive surgical system 100, thecomputer-implemented interactive surgical system 200, the roboticsurgical system 110, the robotic hub 122, the robotic hub 222, and/orthe robotic surgical system 15000, for example.

In various instances, a robotic surgical system can include a roboticcontrol tower, which can house the control unit of the system. Forexample, the control unit 14409 of the robotic surgical system depictedin FIG. 265 can be housed within a robotic control tower. The roboticcontrol tower can include a robot hub such as the robotic hub 122 (FIG.2 ) or the robotic hub 222 (FIG. 9 ), for example. Such a robotic hubcan include a modular interface for coupling with one or moregenerators, such as an ultrasonic generator and/or a radio frequencygenerator, and/or one or more modules, such as an imaging module, asuction module, an irrigation module, a smoke evacuation module, and/ora communication module, for example.

The reader will readily appreciate that the computer-implementedinteractive surgical system 100 (FIG. 1 ) and the computer-implementedinteractive surgical system 200 (FIG. 9 ) disclosed herein canincorporate the robotic arm 14400. Additionally or alternatively, therobotic surgical system depicted in FIG. 265 can include variousfeatures and/or components of the computer-implemented interactivesurgical systems 100 and 200.

A robotic hub can include a situational awareness module, which can beconfigured to synthesize data from multiple sources to determine anappropriate response to a surgical event. For example, a situationalawareness module can determine the type of surgical procedure, step inthe surgical procedure, type of tissue, and/or tissue characteristics,as further described herein. Moreover, such a module can recommend aparticular course of action or possible choices to the robotic systembased on the synthesized data. In various instances, a sensor systemencompassing a plurality of sensors distributed throughout the roboticsystem can provide data, images, and/or other information to thesituational awareness module. Such a situational awareness module can beincorporated into a control unit, such as the control unit 14409, forexample. In various instances, the situational awareness module canobtain data and/or information from a non-robotic surgical hub and/or acloud, such as the surgical hub 106, the surgical hub 206, the cloud104, and/or the cloud 204, for example. Situational awareness of asurgical system is further disclosed herein and in U.S. ProvisionalPatent Application Ser. No. 62/611,341, entitled INTERACTIVE SURGICALPLATFORM, filed Dec. 28, 2017, and in U.S. Provisional PatentApplication Ser. No. 62/611,340, entitled CLOUD-BASED MEDICAL ANALYTICS,filed Dec. 28, 2017, the disclosure of each of which is hereinincorporated by reference in its entirety.

Referring again to FIG. 265 , the robotic arm 14400 does not include alinear slide mechanism for moving the attached surgical tool 14406 alonga longitudinal axis of the tool 14406. Rather, the limbs 14402 of thearm 14400 are configured to rotate about the various joints 14403 of thearm 14400 to move the surgical tool 14406. In other words, even movementof the surgical tool 14406 along the longitudinal axis A_(T) thereofrequires the articulation of various limbs 14402. For example, to movethe surgical tool 14406 along the longitudinal axis A_(T), the roboticarm 14400 would move at multiple revolute joints 14403 thereof. Ineffect, linear displacement of the tool 14406 for extending the endeffector through a trocar, retracting the end effector from the trocar,and/or for localized displacements of the surgical tool 14406 along thelongitudinal axis A_(T), such as during a suturing process, for example,would require the actuation of multiple revolute joints 14403 and thecorresponding movement of multiple rigid limb portions 14402 of the arm14400.

In instances in which a robotic surgical system lacks a linear slidemechanism, as described herein, intelligent sensing systems, additionalcommunication paths, and/or interactive displays can enable more precisecontrol of the robotic arm including the implementation of controlmotions that involve a linear displacement of the surgical tool along anaxis thereof. For example, to ensure the accurate positioning of thetool 14406 and to avoid inadvertent collisions within an operating room,it may be desirable to include additional systems in the robotic systemfor determining the position of a surgical tool 14406 and/or portions ofthe robotic arm 14400, for repositioning of the robotic arm 14400 fromwithin the sterile field, for communicating the position of the surgicaltool 14406 relative to the surgical site, for visualizing the surgicaltool 14406 at the surgical site, and/or for manipulating the surgicaltool 14406 around the surgical site, for example.

In one aspect, a robotic surgical system can include a primary controlmechanism for positioning the tool and a secondary means for directlyand/or independently measuring the position of the tool. In one aspect,a redundant or secondary sensing system can be configured to determineand/or verify a position of a robotic arm and/or a surgical toolattached to the robotic arm. The secondary sensing system can beindependent of a primary sensing system.

In one instance, the primary control mechanism can rely on closed-loopfeedback to calculate the position of the tool. For example, a controlunit of a robotic surgical system can issue control motions for therobotic arm, including the various motors and/or drivers thereof to moveportions of the robotic arm in a three-dimensional space, as furtherdescribed herein. Such a control unit can determine the position and/ororientation of the portions of the robotic arm based on torque sensorson the motors and/or displacement sensors on the drivers, for example.In such instances, the position of the surgical tool, the end effector,and/or components thereof can be determined by proximally-locatedsensors. The proximally-located sensors can be located in a proximalhousing or mounting portion of the tool and/or the robotic arm. In oneinstance, such proximally-located sensors can be positioned outside thesterile field, for example. The position of a surgical tool mounted to arobotic arm can be determined by measuring the angle(s) of each joint ofthe arm, for example. The control unit and sensors in communicationtherewith, which determine the position of the arm based on the controlmotions delivered thereto, can be considered a primary or first sensingsystem of the robotic surgical system.

In addition to a primary sensing system, as described herein, aredundant or secondary sensing system can be employed by the roboticsurgical system. The secondary sensing system can include one or moredistally-located sensors. The distally-located sensors can be positionedwithin the sterile field and/or on the end effector, for example. Thedistally-located sensors are distal to the proximally-located sensors ofthe primary sensing system, for example. In one instance, thedistally-located sensors can be “local” sensors because they are localto the sterile field and/or the surgical site, and theproximally-located sensors can be “remote” sensors because they areremote from the sterile field and/or the surgical site.

Referring now to FIG. 273 , portions of a robotic surgical system 14300are schematically depicted. The robotic surgical system 14300 is similarin many respects to the robotic surgical system of FIG. 265 . Forexample, the robotic surgical system 14300 includes a plurality ofmovable components 14302. In one aspect, the movable components 14302are rigid limbs that are mechanically coupled in series at revolutejoints. Such moveable components 14302 can form a robotic arm, similarto the robotic arm 14440 (FIG. 265 ), for example. The distal-mostcomponent 14302 includes an attachment for releasably attachinginterchangeable surgical tools, such as the surgical tool 14306, forexample. Each component 14302 of the robotic arm has one or more motors14307 and motor drivers 14314, which can be operated to affectrotational motion at the respective joint.

Each component 14302 includes one or more sensors 14308, which can beposition sensors and/or torque sensors, for example. The sensors 14308can provide information regarding the current configuration and/or loadat the respective joint between the components 14402. The motors 14307can be controlled by a control unit 14309, which is configured toreceive inputs from the sensors 14308 and/or from a surgical commandinterface, such as surgical command interface 14412 (FIG. 265 ), forexample.

A primary sensing system 14310 is incorporated into the control unit14309. In one aspect, the primary sensing system 14310 can be configuredto detect the position of one or more components 14302. For example, theprimary sensing system 14310 can include the sensors 14308 for themotors 14307 and/or the drivers 14314. Such sensors 14308 are remotefrom the patient P and located outside of the sterile field. Thoughlocated outside of the sterile field, the primary sensing system 14310can be configured to detect the position(s) of the component(s) 14302and/or the tool 14306 within the sterile field, such as at the positionof the distal end of the robotic arm and/or the attachment portionthereof. Based on the position of the robotic arm and components 14302thereof, the control unit 14309 can extrapolate the position of thesurgical tool 14306, for example.

The robotic surgical system 14300 of FIG. 273 also includes a secondarysensing system 14312 for directly tracking the position and/ororientation or various parts of the robotic surgical system 14300 and/orparts of an associated, non-robotic system such as handheld surgicalinstruments 14350. Referring still to FIG. 273 , the secondary sensingsystem 14312 includes a magnetic field emitter 14320 that is configuredto emit a magnetic field in the vicinity of one or more magnetic sensorsto detect the positions thereof. Components 14302 of the robotic arminclude magnetic sensors 14322, which can be utilized to determineand/or verify the position of the respective components 14302. Themagnetic sensors 14322 are remote to the motors 14307 and the drivers14308, for example. In any event, the torque through the motor and/orthe displacement of a driver may not affect the output from the magneticsensors. Consequently, the sensing systems are independent.

In certain instances, the magnetic sensors 14322 can be positionedwithin the sterile field. For example, the surgical tool 14306 caninclude the magnetic sensor 14324, which can be utilized to determineand/or verify the position of the surgical tool 14306 attached to therobotic arm and/or to determine and/or verify the position of acomponent of the surgical tool 14306, such as a firing element, forexample. Additionally or alternatively, one or more patient sensors14326 can be positioned within the patient P to measure the patient'slocation and/or anatomic orientation. Additionally or alternatively, oneor more trocar sensors 14328 can be positioned on a trocar 14330 tomeasure the trocar's location and/or orientation, for example.

Referring again to the robotic arm 14400 depicted in FIG. 265 , thesurgical tool 14406 is attached to the attachment portion 14405 at thedistal end of the robotic arm 14400. When the surgical tool 14406 ispositioned within a trocar, the robotic surgical system can establish avirtual pivot which can be fixed by the robotic surgical system, suchthat the arm 14400 and/or the surgical tool 14406 can be manipulatedthereabout to avoid and/or minimize the application of lateral forces tothe trocar. In certain instances, applying force(s) to the trocar maydamage the surrounding tissue, for example. Thus, to avoid inadvertentdamage to tissue, the robotic arm 14400 and/or the surgical tool 14406can be configured to move about the virtual pivot of the trocar withoutupsetting the position thereof and, thus, without upsetting thecorresponding position of the trocar. Even when applying a lineardisplacement of the surgical tool 14406 to enter or exit the trocar, thevirtual pivot can remain undisturbed.

In one aspect, the trocar sensor(s) 14328 in FIG. 273A can be positionedat a virtual pivot 14332 on the trocar 14330. In other instances, thetrocar sensors 14328 can be adjacent to the virtual pivot 14332.Placement of the trocar sensors 14328 at and/or adjacent to the virtualpivot 14332 thereof can track the position of the trocar 14330 andvirtual pivot 14332 and help to ensure that the trocar 14330 does notmove during displacement of the surgical tool 14306, for example. Insuch instances, without physically engaging or holding the trocar 14330,the robotic surgical system 14300 can confirm and/or maintain thelocation of the trocar 14330. For example, the secondary sensing system14312 can confirm the location of the virtual pivot 14332 of the trocar14330 and the surgical tool 14306 relative thereto.

Additionally or alternatively, one or more sensors 14352 can bepositioned on one or more handheld surgical instruments 14350, which canbe employed during a surgical procedure in combination with the surgicaltools 14306 utilized by the robotic surgical system 14300. The secondarysensing system 14312 is configured to detect the position and/ororientation of one or more handheld surgical instruments 14350 withinthe surgical field, for example, within the operating room and/orsterile field. Such handheld surgical instruments 14350 can includeautonomous control units, which may not be robotically controlled, forexample. As depicted in FIG. 273 , the handheld surgical instruments14350 can include sensors 14352, which can be detected by the magneticfield emitter 14320, for example, such that the position and/or locationof the handheld surgical instruments 14350 can be ascertained by therobotic surgical system 14300. In other instances, components of thehandheld surgical instruments 14350 can provide a detectable output. Forexample, a motor and/or battery pack can be detectable by a sensor inthe operating room.

In one aspect, the magnetic field emitter 14320 can be incorporated intoa main robot tower. The sensors 14322, 14324, 14326, 14328, and/or 14352within the sterile field can reflect the magnetic field back to the mainrobot tower to identity the positions thereof. In various instances,data from the magnetic field emitter 14320 can be communicated to adisplay 14340, such that the position of the various components of thesurgical robot, surgical tool 14302, trocar 14330, patient P, and/orhandheld surgical instruments 14350 can be overlaid onto a real-timeview of the surgical site, such as views obtained by an endoscope at thesurgical site. For example, the display 14340 can be in signalcommunication with the control unit of the robotic surgical systemand/or with a robotic hub, such as the hub 106, robotic hub 122, the hub206, and/or the robot hub 222 (FIG. 9 ), for example.

In other instances, the magnetic field emitter 14320 can be external tothe robot control tower. For example, the magnetic field emitter 14320can be incorporated into a hub.

Similar to the secondary sensing system 14312, which includes themagnetic field emitter 14320, in certain instances, time-of-flightsensors can be positioned on one or more of the robot component(s)14302, the surgical tool(s) 14306, the patient P, the trocar(s) 14328,and/or the handheld surgical instrument(s) 14350 to provide an array ofdistances between the emitter and the reflector points. Suchtime-of-flight sensors can provide primary or secondary (e.g. redundant)sensing of the position of the robot component(s) 14302, the surgicaltool(s) 14306, the patient P, the trocar(s) 14328, and/or the handheldsurgical instrument(s) 14350, for example. In one instance, thetime-of-flight sensor(s) can employ an infrared light pulse to providedistance mapping and/or facilitate 3D imaging within the sterile field.

In one instance, the secondary sensing system 14312 can include aredundant sensing system that is configured to confirm the position ofthe robotic components and/or tools. Additionally or alternatively, thesecondary sensing system 14312 can be used to calibrate the primarysensing system 14310. Additionally or alternatively, the secondarysensing system 14312 can be configured to prevent inadvertententanglement and/or collisions between robotic arms and/or components ofa robotic surgical system.

Referring again to FIG. 273 , in one instance, the components 14302 ofthe robotic surgical system 14300 can correspond to discrete roboticarms, such as the robotic arms 15024 in the robotic surgical system15000 (FIG. 22 ) and/or the robotic arms depicted in FIG. 2 , forexample. The secondary sensing system 14312 can be configured to detectthe position of the robotic arms and/or portions thereof as the multiplearms are manipulated around the surgical theater. In certain instances,as one or more arms are commanded to move towards a potential collision,the secondary sensing system 14312 can alert the surgeon via an alarmand/or an indication at the surgeon's console in order to prevent aninadvertent collision of the arms.

Referring now to FIG. 274 , a flow chart for a robotic surgical systemis depicted. The flow chart can be utilized by the robotic surgicalsystem 14300 (FIG. 273 ), for example. In various instances, twoindependent sensing systems can be configured to detect the locationand/or orientation of a surgical component, such as a portion of arobotic arm and/or a surgical tool. The first sensing system, or primarysensing system, can rely on the torque and/or load sensors on the motorsand/or motor drivers of the robotic arm. The second sensing system, orsecondary sensing system, can rely on magnetic and/or time-of-flightsensors on the robotic arm and/or surgical tool. The first and secondsensing systems are configured to operate independently and in parallel.For example, at step 14502, the first sensing system determines thelocation and orientation of a robotic component and, at step 14504,communicates the detected location and orientation to a control unit.Concurrently, at step 14506, the second sensing system determines thelocation and orientation of the robotic component and, at step 14508,communicates the detected location and orientation to the control unit.

The independently-ascertained locations and orientations of the roboticcomponent are communicated to a central control unit at step 14510, suchas to the robotic control unit 14309 and/or a surgical hub. Uponcomparing the locations and/or orientations, the control motions for therobotic component can be optimized at step 14512. For example,discrepancies between the independently-determined positions can be usedto improve the accuracy and precision of control motions. In certaininstances, the control unit can calibrate the control motions based onthe feedback from the secondary sensing system. The data from theprimary and secondary sensing systems can be aggregated by a hub, suchas the hub 106 or the hub 206, for example, and/or data stored in acloud, such as the cloud 104 or the cloud 204, for example, to furtheroptimize the control motions of the robotic surgical system.

In certain instances, the robotic system 14300 can be in signalcommunication with a hub, such as the hub 106 of the hub 206, forexample. The hubs 106, 206 can include a situational awareness module,as further described herein. In one aspect, at least one of the firstsensor system 14310 and the second sensor system 14312 are data sourcesfor the situational awareness module. For example, the sensor systems14310 and 14312 can provide position data to the situational awarenessmodule. Further, the hub 106, 206 can be configured to optimize and/orcalibrate the control motions of the robotic arm 14300 and/or thesurgical tool 14306 based on the data from the sensor systems incombination with the situational awareness, for example. In one aspect,a sensing system, such as the secondary sensing system 14312 can informthe hub 106, 206 and situational awareness module thereof when ahandheld surgical instrument 14350 has entered the operating room orsurgical theater and/or when an end effector has been fired, forexample. Based on such information, the hub 106, 206 can determineand/or confirm the particular surgical procedure and/or step thereof.

The reader will appreciate that various independent and redundantsensing systems disclosed herein can be utilized by a robotic surgicalsystem to improve the accuracy of the control motions, especially whenmoving the surgical tool along a longitudinal axis without relying on alinear slide mechanism, for example.

In one aspect, the surgical hub includes a processor and a memorycommunicatively coupled to the processor, as described herein. Thememory stores instructions executable by the processor to detect aposition of a robotically-controlled component independent of a primarysensing system, as described above.

In various aspects, the present disclosure provides a control circuitconfigured to detect a position of a robotically-controlled componentindependent of a primary sensing system, as described above. In variousaspects, the present disclosure provides a non-transitory computerreadable medium storing computer readable instructions which, whenexecuted, cause a machine to detect a position of arobotically-controlled component independent of a primary sensingsystem, as described above.

In one aspect, a robotic surgical system can be configured to wirelesslycommunicate with one or more intelligent surgical tools mounted to arobotic arm thereof. The control unit of the robotic system cancommunicate with the one or more intelligent surgical tools via awireless connection, for example. Additionally or alternatively, therobotic surgical system can include a robotic hub, which can wirelesslycommunicate with the intelligent surgical tool(s) mounted to the roboticarm(s). In still other instances, a non-robotic surgical hub canwirelessly communicate with the intelligent surgical tool(s) mounted toa robotic arm. In certain instances, information and/or commands can beprovided to the intelligent surgical tool(s) from the control unit viathe wireless connection. For example, certain functions of a surgicaltool can be controlled via data received through a wirelesscommunication link on the surgical tool. Similarly, in one aspect,closed-loop feedback can be provided to the robotic surgical system viadata received via the wireless communication link to the surgical tool.

Referring primarily to FIGS. 270-272 , a surgical tool 14206 is mountedto a robotic arm 14000 of a surgical robot. The robotic arm 14000 issimilar in many respects to the robotic arm 14400 in FIG. 265 . Forexample, the arm 14000 includes a plurality of movable components 14002.In one aspect, the movable components 14002 are rigid limbs that aremechanically coupled in series at revolute joints 14003. Such moveablecomponents 14002 form the robotic arm 14400, similar to the arm 14400(FIG. 265 ), for example. A distal-most component 14002 c of the roboticarm 14400 includes an attachment 14005 for releasably attachinginterchangeable surgical tools, such as the surgical tool 14206. Eachcomponent 14002 of the arm 14000 has one or more motors and motordrivers, which can be operated to affect rotational motion at therespective joint 14003.

Each component 14002 includes one or more sensors, which can be positionsensors and/or torque sensors, for example, and can provide informationregarding the current configuration and/or load at the respective jointbetween the components 14002. The motors can be controlled by a controlunit, such as the control unit 14409 (FIG. 265 ), which is configured toreceive inputs from the sensors 14008 and/or from a command interface,such as the surgeon's command console 14412 (FIG. 265 ), for example.

The surgical tool 14206 is a linear stapler including a wirelesscommunication module 14208 (FIG. 271 ). The linear stapler can be anintelligent linear stapler and can include an intelligent fastenercartridge, an intelligent end effector, and/or an intelligent shaft, forexample. Intelligent surgical components can be configured to determinevarious tissue properties, for example. In one instance, one or moreadvanced end effector functions may be implemented based on the detectedtissue properties. A surgical end effector can include one or moresensors for determining tissue thickness, compression, and/or impedance,for example. Moreover, certain sensed parameters can indicate tissuevariations, such as the location of a tumor, for example. Intelligentsurgical devices for sensing various tissue properties are furtherdisclosed the following references:

-   -   U.S. Pat. No. 9,757,128, filed Sep. 5, 2014, entitled MULTIPLE        SENSORS WITH ONE SENSOR AFFECTING A SECOND SENSOR'S OUTPUT OR        INTERPRETATION, which issued on Sep. 12, 2017;    -   U.S. patent application Ser. No. 14/640,935, entitled OVERLAID        MULTI SENSOR RADIO FREQUENCY (RF) ELECTRODE SYSTEM TO MEASURE        TISSUE COMPRESSION, filed Mar. 6, 2015, now U.S. Patent        Application Publication No. 2016/0256071, which published on        Sep. 8, 2016;    -   U.S. patent application Ser. No. 15/382,238, entitled MODULAR        BATTERY POWERED HANDHELD SURGICAL INSTRUMENT WITH SELECTIVE        APPLICATION OF ENERGY BASED ON TISSUE CHARACTERIZATION, filed        Dec. 16, 2016, now U.S. Patent Application Publication No.        2017/0202591, which published on Jul. 20, 2017; and    -   U.S. patent application Ser. No. 15/237,753, entitled CONTROL OF        ADVANCEMENT RATE AND APPLICATION FORCE BASED ON MEASURED FORCES,        filed Aug. 16, 2016, now U.S. Patent Application Publication No.        2018/0049822, which published on Feb. 22, 2018;        each of which is herein incorporated by reference in its        entirety.

As depicted in FIG. 270 , a wireless communication link 14210 isprovided between the surgical tool 14206 and a hub 14212. The hub 14212is a surgical hub, like the hub 106 or the hub 206, for example. Inother instances, the hub 14212 can be a robotic hub, like the robotichub 122 or the robotic hub 222, for example. In FIG. 270 , the wirelesscommunication module 14208 includes a wireless signal transmitter thatis located near the distal end of the end effector of the surgical tool14206. In other instances, the wireless transmitter can be positioned ona proximal portion of the end effector or on the shaft of the surgicaltool 14206.

The wireless communication link 14212 between the surgical tool 14206and the surgical hub 14212 provides real-time data transfer through asterile barrier 14230. Additionally or alternatively, the wirelesscommunication module 14208 can be configured to communicate with a robotcontrol tower and/or the control unit, which issues the control motionsto the robotic arm 14000 and actuations to the surgical tool 14206 basedon inputs at the surgeon's command console. In certain instances, thecontrol unit for the robotic arm 14000 can be incorporated into thesurgical hub 14212 and/or a robotic hub, such as the robotic hub 122(FIG. 2 ) or the robotic hub 222 (FIG. 9 ), for example.

In certain instances, it can be difficult to confirm the position of thesurgical tool 14206 within the surgical theater, around the surgicalsite, and/or relative to the targeted tissue. For example, lateraldisplacement of the surgical tool 14206 can be constrained by a physicalboundary, such as a longitudinally-extending trocar, for example. Insuch instances, lateral displacement of the surgical tool 14206 can bedetermined by a resistance force from and/or on the trocar. Conversely,linear displacement of the surgical tool 14206 can be unconstrained byphysical boundaries of the surgical system. In such instances, when thecontrol unit directs linear displacement of the surgical tool 14206 or aportion thereof, and the various movable links 14002 and joints 14003articulate to affect the linear displacement, it can be difficult todetermine and/or confirm the position of the surgical tool 14206 andrespective portions thereof.

When the surgical tool 14206 is moved along the longitudinal axis of thetool A_(T) (FIG. 271 ), which is collinear with the shaft of thesurgical tool 14206, it can be difficult to determine and/or confirm theexact position of the surgical tool 14206. In certain instances, asprovided herein, the robotic surgical system can include a secondarysensing system, which is configured to detect the position of thesurgical tool 14206. For example, the wireless communication module14208 can be in signal communication with a secondary sensing system,such as the secondary sensing system 14312 (FIG. 273 ) and/or a sensorthereof. Moreover, the wireless communication module 14208 cancommunicate the position of the surgical tool 14206, as detected by thesecondary sensing system 14312, to the surgical hub 14212 via thewireless communication link 14210. Additionally or alternatively, thewireless communication module 14208 can communicate information from thevarious sensors and/or systems of the intelligent surgical tool 14206 tothe surgical hub 14212. The surgical hub 14212 can disseminate theinformation to displays within the operating room or external displays,to a cloud, and/or to one or more hubs and/or control units used inconnection with the surgical procedure.

Referring primarily to FIG. 271 , in one instance, the surgical tool14206 can be employed to remove a cancerous tumor 14242 from patienttissue T. To ensure complete removal of the tumor 14242 while minimizingthe removal of healthy tissue, a predefined margin zone 14240 can bedefined around the tumor 14242. The margin zone can be determined by thesurgeon based on patient data, aggregated data from a hub and/or acloud, and/or data sensed by one or more intelligent components of thesurgical system, for example. During the operation, the surgical tool14206 can transect the tissue T along the margin zone 14240 such thatthe margin zone 14240 is removed along with the tumor 14242. The primaryand secondary sensing systems 14310 and 14312 (FIG. 273 ) can determinethe position of the surgical tool 14206 relative to the margin zone, forexample. Moreover, the wireless communication module 14208 cancommunicate the detected position(s) to the control unit.

In certain instances, the robotic system of FIGS. 271 and 272 can beconfigured to actuate (e.g. fire) the surgical tool 14206 when thesurgical tool 14206 moves within the margin zone 14240. For example,referring primarily to FIG. 272 , a graphical display 14250 of distanceand force-to-close over time for the linear stapler 14206 during thesurgical procedure of FIG. 270 is depicted. As the surgical tool 14206approaches the margin zone 14240 at time t₁, the force-to-close (FTC)increases indicating that the surgical tool 14206 is being clamped ontissue T around the tumor 14242 between time t₁ and time t₂. Morespecifically, the surgical tool 14206 is clamped when moved intoposition a distance between distances D₁ and D₂. The distance D₁ canrefer to the outer boundary of the margin zone 14240 around the tumor14242, for example, and the distance D₂ can refer to the inner boundaryof the margin zone 14240, which can be assumed boundary of the tumor14242, for example.

In various instances, the control unit and the processor thereof canautomatically affect the clamping motion when the surgical tool 14206 ispositioned at the appropriate distance based on input from a primarysensing system and/or a secondary sensing system. In other instances,the control unit and the processor thereof can automatically alert thesurgeon that the surgical tool 14206 is positioned at the appropriatedistance. Similarly, in certain instances, the processor canautomatically fire the surgical tool 14206 and/or suggest to the surgeonthat the surgical tool 14206 be fired based on the detected position(s)of the surgical tool 14206. The reader will readily appreciate thatother actuation motions are envisioned, such as energizing an energytool and/or articulating and articulatable end effector, for example.

In certain instances, the hub 14212 can include a situational awarenesssystem, as further described herein. In one aspect, the position of thetumor 14242 and/or the margin zone 14240 therearound can be determinedby the situational awareness system or module of the hub 14212. Incertain instances, the wireless communication module 14208 can be insignal communication with the situational awareness module of the hub14212. For example, referring again to FIG. 86 , the stapler data and/orthe cartridge data provided at steps 5220 and 5222 can be provided viathe wireless communication module 14208 of the stapling tool 14206, forexample.

In one aspect, sensors positioned on the surgical tool 14206 can beutilized to determine and/or confirm the position of the surgical tool14206 (i.e. a secondary sensing system). Moreover, the detected positionof the linear stapler can be communicated to the surgical hub 14212across the wireless communication link 14210, as further describedherein. In such instances, the surgical hub 14212 can obtain real-time,or near real-time, information regarding the position of the surgicaltool 14206 relative to the tumor 14242 and the margin zone 14240 basedon the data communicated via the wireless communication link 14230. Invarious instances, the robotic surgical system can also determine theposition of the surgical tool 14206 based on the motor controlalgorithms utilized to position the robotic arm 14000 around thesurgical theater (i.e. a primary sensing system).

In one aspect, a robotic surgical system can integrate with an imagingsystem. Real-time feeds from the surgical site, which are obtained bythe imaging system, can be communicated to the robotic surgical system.For example, referring again to FIGS. 2 and 3 , real-time feeds from theimaging module 138 in the hub 106 can be communicated to the roboticsurgical system 110. For example, the real-time feeds can becommunicated to the robotic hub 122. In various instances, the real-timefeed can be overlaid onto one or more active robot displays, such as thefeeds at the surgeon's command console 118. Overlaid images can beprovided to one or more displays within the surgical theater, such asthe displays 107, 109, and 119, for example.

In certain instances, the overlay of real-time feeds onto a robotdisplay can enable the surgical tools to be precisely controlled withinan axes system that is defined by the surgical tool and/or the endeffector(s) thereof as visualized by the real-time imaging system. Invarious instances, cooperating between the robotic surgical system 110and the imaging system 138 can provide triangulation and instrumentmapping of the surgical tools within the visualization field, which canenable precise control of the tool angles and/or advancements thereof.Moreover, shifting control from a standard multi-axes, fixed Cartesiancoordinate system to the axis defined by the currently-mounted tooland/or to the end effector thereof can enable the surgeon to issuecommands along clear planes and/or axes. For example, a processor of therobotic surgical system can direct a displacement of a surgical toolalong the axis of the elongate shaft of the surgical tool or a rotationof the surgical tool at a specific angle from the current position basedon a selected point to rotate about. In one exemplification, theoverlaid feed of a surgical tool can incorporate a secondary orredundant sensing system, as further described herein, to determine thelocation and/or orientation of the surgical tool.

In certain instances, a robotic arm, such as the robotic arm 14400 (FIG.265 ) can be significantly heavy. For example, the weight of a roboticarm can be such that manually lifting or repositioning the robotic armis difficult for most able-bodied clinicians. Moreover, the motors anddrive mechanisms of the robotic arm may only be controlled by a primarycontrol system located at the control unit based on inputs from thesurgeon's command console. Stated differently, a robotic surgicalsystem, such as the system depicted in FIG. 265 , for example, may notinclude a secondary control system for the robotic arm 14400 that islocal to the robotic arm 14400 and within the sterile field.

A robotic arm in a robotic surgical system may be prone to inadvertentcollisions with equipment and/or people within the sterile field. Forexample, during a surgical procedure, surgeon(s), nurse(s), and/ormedical assistant(s) positioned within the sterile field may move aroundthe sterile field and/or around the robotic arms. In certain instances,the surgeon(s), nurse(s), and/or medical assistant(s), for example, mayreposition equipment within the sterile field, such as tables and/orcarts, for example. When a surgeon positioned outside of the sterilefield is controlling the robotic arm, another surgeon, nurse, and/ormedical assistant positioned within the sterile field may also want tomanually move and/or adjust the position of one of more robotic arms inorder to avoid a potential collision with the arm(s), entanglement ofthe arm with other equipment and/or other arms, and/or to replace,reload, and/or reconfigure a surgical tool mounted to the arm. However,to reposition the robotic arm, the surgeon may need to power down therobotic surgical system to enable the clinician within the sterile fieldto manually reposition the robotic arm. In such instances, the cliniciancan be required to carry the significant weight of the unpowered, orpowered down, robotic arm.

In one instance, a robotic surgical system can include an interactivedisplay that is local to the sterile field and/or local to the roboticarm(s). Such a local display can facilitate manipulation and/orpositioning of the arm(s) by a clinician within the sterile field.Stated differently, an operator other than the surgeon at the commandconsole can control the position of the robotic arm(s).

Referring now to FIG. 266 , a clinician is applying a force to therobotic arm 14000 to manually adjust the position of the robotic arm14000. In certain instances, the robotic surgical system employing therobotic arm 14000 can employ a passive power assist mode, in which therobotic arm 14400 can easily be repositioned by a clinician within thesterile field. For example, though the robotic arm 14000 is powered andis controlled by a remote control unit, the clinician can manuallyadjust the position of the robotic arm 14000 without requiring theclinician to carry the entire weight of the robotic arm 14000. Theclinician can pull and/or push the robotic arm 14000 to adjust theposition thereof. In the passive power assist mode, the power to therobotic arm 14000 can be constrained and/or limited to permit thepassive repositioning by the clinician.

Referring now to FIG. 267 , a graphical display 14050 of force over timeof the robotic arm 14000 (FIG. 266 ) in a passive power assist mode isdepicted. In the passive power assist mode, a clinician can apply amanual force to the robotic arm 14000 to initiate the repositioning ofthe robotic arm 14000. The clinician can be within the sterile field. Incertain instances, the passive power assist mode can be activated whenthe robotic arm 14000 senses a manual manipulation.

As depicted in FIG. 267 , the manual force exerted by a clinician canincrease to exceed a predefined threshold, such as the 15-lb limitindicated in FIG. 267 , for example, to affect repositioning of therobotic arm 14000. In certain instances, the predefined threshold cancorrespond to the maximum force an able-bodied assist can easily exerton the robotic arm 14000 without undue stress or strain. In otherinstances, the predefined threshold can correspond to a minimumthreshold force on the robotic arm 14000 in order to avoid providing apowered assist to unintentional or inadvertent contacts with the roboticarm 14000.

When the user exerts a force on the robotic arm 14000 above thepredefined threshold, one or more motors (e.g. motors 14407 in FIG. 265) of the robotic surgical system can apply an assisting force to therobotic arm 14000 to help reposition the robotic arm 14000 in thedirection indicated by the operator's force on the robotic arm 14000. Insuch instances, the operator can easily manipulate the position of thearm to avoid inadvertent collisions and/or entanglements and, when theoperator's force exceeds a comfortable threshold force, the motors canassist or cooperate in the repositioning of the arm. The passive powerassist provided by the motors of the robotic surgical system cancompensate for the weight of the robotic arm 14000. In other instances,the assisting force can be less than the weight of the robotic arm14000. In certain instances, the assisting force can be capped at amaximum force, such as the 5-lb limit indicated in FIG. 267 , forexample. Capping the assisting force may ensure that the robotic arm14000 does not forcefully collide with a person, surgical equipment,and/or another robotic arm in the surgical theater.

In one aspect, the passive power assist mode can be deactivated orlocked out during portions of a surgical procedure. For example, when asurgical tool is positioned at the surgical site or within a predefinedradius of the surgical site and/or the target tissue, the passive powerassist mode can be locked out. Additionally or alternatively, duringcertain steps of a surgical procedure the passive power assist mode canbe locked out. Situational awareness can be configured to determinewhether the passive power assist mode should be locked out. For example,based on information that a hub knows regarding the step of the surgicalprocedure (see, e.g. FIG. 86 ), a passive power assist mode may beill-advised by the situational awareness module. Similarly, the passivepower assist mode can be activated during certain portions of thesurgical timeline shown in FIG. 86 .

In one aspect, the control unit for operating a robotic arm includes aprocessor and a memory communicatively coupled to the processor, asdescribed herein. The memory stores instructions executable by theprocessor to operate in a passive power assist mode in which theprocessor is configured to process a manual force applied to the roboticarm and, if the manual force exceeds a predefined threshold, to directone or more motors of the robotic arm to provide an assisting force toreposition the robotic arm in the direction indicated by the manualforce.

In various aspects, the present disclosure provides a control circuitconfigured to operate a passive power assist mode, as described above.In various aspects, the present disclosure provides a non-transitorycomputer readable medium storing computer readable instructions which,when executed, cause a machine to operate a passive power assist mode,as described above.

Referring now to FIGS. 268 and 269 , a clinician within the sterilefield is utilizing a local control module 14160 within a sterile fieldto affect repositioning of a robotic arm 14100. The robotic arm 14100 issimilar in many respects to the robotic arm 14400 in FIG. 265 . Forexample, the robotic arm 14100 includes a plurality of movablecomponents 14102. The movable components 14102 are rigid limbs that aremechanically coupled in series at revolute joints 14103. The moveablecomponents 14102 form the robotic arm 14100, similar to the robotic arm14400 (FIG. 265 ), for example. A distal-most component 14102 c includesan attachment 14105 for releasably attaching interchangeable surgicaltools, such as the surgical tool 14106, for example. Each component14102 of the robotic arm 14100 has one or more motors and motor drivers,which can be operated to affect rotational motion at the respectivejoint 14103.

Each component 14102 includes one or more sensors, which can be positionsensors and/or torque sensors, for example, and can provide informationregarding the current configuration and/or load at the respective jointbetween the components 14102. The motors can be controlled by a controlunit, such as the control unit 14409 (FIG. 265 ), which is configured toreceive inputs from the sensors and/or from a surgical commandinterface, such as the surgical command interface 14412 (FIG. 265 ), forexample.

The local control module 14160 includes an interactive display 14164 anda touch screen 14166 that is configured to accept inputs, such as inputsfrom a finger and/or a stylus 14168, for example. The local controlmodule 14160 is a handheld, mobile digital electronic device. Forexample, the local control module 14160 can be an iPad® tablet or othermobile tablet or smart phone, for example. In use, the clinicianprovides repositioning instructions to the robotic arm 14100 via thedisplay 14164 and/or the touch screen 14166 of the local control module14160. The local control module 14160 is a wireless communication module14162 such that the inputs from the clinician can be communicated to therobotic arm 14140 to affect arm control motions. The local controlmodule 14140 can wirelessly communicate with the robotic arm 14140and/or a control unit (e.g. the control unit 14409 in FIG. 265 ) of therobotic system via a Wi-Fi connection, for example.

The robotic arm 14100 includes six degrees of freedom indicated by thesix arrows in FIG. 268 . The proximal degrees of freedom can becontrolled by the local control module 14160 and the distal degrees offreedom can be controlled by the remote control module. In one instance,the three most-proximal degrees of freedom (articulation about the twomost-proximal joints 14103 and rotation of the intermediate limb 14102about the axis thereof) can be controlled by the local control moduleand the three most-distal degrees of freedom (articulation about themost-distal joint 14103, rotation of the most-distal limb 14102 c aboutthe axis thereof, and displacement of the surgical tool 14106 along theaxis thereof) can be controlled by the remote control module. In suchinstances, the clinician within the sterile field can affect grossrobotic arm control motions, such as control motions of the proximalarms and/or joints. For example, the clinician within the sterile fieldcan quickly and easily move a robotic arm to a general position, such asa pre-operative position, tool exchanging position, and/or reloadingposition via the local control module 14160. In such instances, thelocal control module 14160 is a secondary control system for the roboticarm 14100. The surgeon outside the sterile field can affect morelocalized or finessed robotic arm control motions via inputs at thesurgeon's command interface 14412 (FIG. 265 ). In such instances, thesurgeon's command interface 14412 outside the sterile field is theprimary control system.

The reader will readily appreciate that fewer or greater than sixdegrees of freedom are contemplated. Alternative degrees of freedom arealso contemplated. Moreover, different degrees of freedom can beassigned to the local control module 14160 and/or the remote controlmodule. In certain instances, one or more degrees of freedom can beassigned to both the local control module 14106 and the remote controlmodule.

Referring primarily now to FIG. 269 , a graphical display 14150 of forceover time of the robotic arm 14100 is depicted. From time 0 to time t₁,locally-actuated, in-field forces are applied to the robotic arm 14100by a clinician within the sterile field to adjust the general positionof the robotic arm 14100. In certain instances, the force attributableto inputs from the local control module 14160 can be capped at a firstmaximum force (for example the 50-lb limit indicated in FIG. 269 ). Byutilizing the local control module 14160, the clinician within thesterile field can quickly reposition the robotic arm 14100 to exchangeand/or reload the surgical tool 14160, for example. Time 0 to time t₁can correspond to a local actuation mode. Active setup or reloading timein a surgical procedure can occur during the local actuation mode. Forexample, during the local actuation mode, the robotic arm 14100 can beout of contact with patient tissue and/or outside a predefined boundaryaround the surgical site, for example.

Thereafter, the surgeon at the surgeon's command console can furtheractuate the robotic arm 14100. For example, from time t₂ to time t₃, theremotely-actuated forces are attributable to inputs from the surgeon'scommand console. The remotely-actuated forces can be capped at a secondmaximum force (for example the 5-lb limit indicated in FIG. 269 ), whichis less than the first maximum force. By limiting the second maximumforce, a surgeon is less likely to cause a high-force or high-speedcollision within the sterile field while the larger first maximum forceallows the robotic arm 14100 to be quickly repositioned in certaininstances. Time t₂ to time t₃ can correspond to a remote actuation modeduring a surgical procedure, which can include when the robotic tool14106 is actively manipulating tissue (grasping, pulling, holding,transecting, sealing, etc.) and/or when the robotic arm 14100 and/orsurgical tool 14106 thereof is within the predefined boundary around thesurgical site.

In one aspect, the local actuation mode and/or the remote actuation modecan be deactivated or locked out during portions of a surgicalprocedure. For example, the local actuation mode can be locked out whenthe surgical tool is engaged with tissue or otherwise positioned at thesurgical site. Situational awareness can be configured to determinewhether the local actuation mode should be locked out. For example,based on information that a hub knows regarding the step of the surgicalprocedure (see, e.g. FIG. 86 ), a local actuation mode may beill-advised by the situational awareness module. Similarly, the remoteactuation mode may be ill-advised during other portions of the surgicalprocedure.

In one aspect, the control unit for operating a robotic arm includes aprocessor and a memory communicatively coupled to the processor, asdescribed herein. The memory stores instructions executable by theprocessor to provide control motions to the robotic arm based on inputfrom a local control module during portion(s) of a surgical procedureand to provide control motions to the robotic arm based on input from aremote control module during portion(s) of the surgical procedure. Afirst maximum force can limit the control motions from the local controlmodule and a second maximum force can limit the control motions from theremote control module.

In various aspects, the present disclosure provides a control circuitconfigured to operate a robotic arm via a local control module and aremote control module, as described above. In various aspects, thepresent disclosure provides a non-transitory computer readable mediumstoring computer readable instructions which, when executed, cause amachine to operate a robotic arm via a local control module and a remotecontrol module, as described above.

The entire disclosures of:

-   -   U.S. Pat. No. 9,072,535, filed May 27, 2011, entitled SURGICAL        STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT        ARRANGEMENTS, which issued Jul. 7, 2015;    -   U.S. Pat. No. 9,072,536, filed Jun. 28, 2012, entitled        DIFFERENTIAL LOCKING ARRANGEMENTS FOR ROTARY POWERED SURGICAL        INSTRUMENTS, which issued Jul. 7, 2015;    -   U.S. Pat. No. 9,204,879, filed Jun. 28, 2012, entitled FLEXIBLE        DRIVE MEMBER, which issued on Dec. 8, 2015;    -   U.S. Pat. No. 9,561,038, filed Jun. 28, 2012, entitled        INTERCHANGEABLE CLIP APPLIER, which issued on Feb. 7, 2017;    -   U.S. Pat. No. 9,757,128, filed Sep. 5, 2014, entitled MULTIPLE        SENSORS WITH ONE SENSOR AFFECTING A SECOND SENSOR'S OUTPUT OR        INTERPRETATION, which issued on Sep. 12, 2017;    -   U.S. patent application Ser. No. 14/640,935, entitled OVERLAID        MULTI SENSOR RADIO FREQUENCY (RF) ELECTRODE SYSTEM TO MEASURE        TISSUE COMPRESSION, filed Mar. 6, 2015, now U.S. Patent        Application Publication No. 2016/0256071;    -   U.S. patent application Ser. No. 15/382,238, entitled MODULAR        BATTERY POWERED HANDHELD SURGICAL INSTRUMENT WITH SELECTIVE        APPLICATION OF ENERGY BASED ON TISSUE CHARACTERIZATION, filed        Dec. 16, 2016, now U.S. Patent Application Publication No.        2017/0202591; and    -   U.S. patent application Ser. No. 15/237,753, entitled CONTROL OF        ADVANCEMENT RATE AND APPLICATION FORCE BASED ON MEASURED FORCES,        filed Aug. 16, 2016, now U.S. Patent Application Publication No.        2018/0049822;        are herein incorporated by reference in their respective        entireties.

During various surgical procedures, a surgeon, or other clinician, mayapply a clip to a patient's tissue in order to achieve various effectsand/or therapeutic results. Referring to FIG. 275 , a surgicalinstrument, such as a clip applier 100, for example, can be configuredto apply one or more clips to tissue located within a surgical site inthe patient. Generally, referring now to FIG. 287 , the clip applier 100can be structured and arranged to position a clip 140 relative to thetissue in order to compress the tissue within the clip 140. The clipapplier 100 can be configured to deform the clip 140 as illustrated inFIGS. 277 and 278 , for example, and as described in greater detailfurther below. Each clip 140 can comprise a base 142 and opposing legs144 extending from the base 142. The base 142 and the legs 144 cancomprise any suitable shape and can define a substantially U-shapedconfiguration and/or a substantially V-shaped configuration, forexample. The base 142 can comprise angled portions 141 which areconnected together by a joint 143. In use, the legs 144 of the clip 140can be positioned on opposite sides of the tissue wherein the legs 144can be pushed toward one another to compress the tissue positionedbetween the legs 144. The joint 143 can be configured to permit theangled portions 141 of the base 142, and the legs 144 extendingtherefrom, to deform inwardly. In various circumstances, the clip 140can be configured to yield, or deform plastically, when the clip 140 issufficiently compressed, although some amount of elastic deformation, orspring-back, may occur within the deformed clip 140.

Referring now to FIGS. 275 and 276 , the clip applier 100 can include ashaft 110, an end effector 120, and a replaceable clip cartridge, ormagazine, 130. Referring to FIGS. 288-290 , the clip cartridge 130 cancomprise a housing 132 and a plurality of clips 140 positioned withinthe housing 132. The housing 132 can define a storage chamber 134 inwhich the clips 140 can be stacked. The storage chamber 134 can comprisesidewalls which extend around, or at least substantially around, theperimeter of the clips 140. Referring again to FIG. 287 , each clip 140can comprise opposing faces, such as a top face 145 and a bottom face146 on opposite sides of the clip 140 wherein, when the clips 140 arestacked in the housing 132, the top face 145 of a clip 140 can bepositioned against the bottom face 146 of an adjacent clip 140 andwherein the bottom face 146 of the clip 140 can be positioned againstthe top face 145 of another adjacent clip 140. In various circumstances,the bottom faces 146 of the clips 140 can face downwardly toward one ormore support shelves, or platforms, 135 defined in the housing 132 whilethe top faces 145 of the clips 140 can face upwardly away from thesupport shelves 135. The top faces 145 and the bottom faces 146 of theclips 140 may be identical, or at least substantially identical, in somecases, while, in other cases, the top faces 145 and the bottom faces 146may be different. The stack of clips 140 depicted in FIGS. 288-290comprises five clips 140, for example; however, other embodiments areenvisioned in which the stack of clips 140 can include more than fiveclips 140 or less than five clips 140. In any event, the clip cartridge130 can further comprise at least one biasing member, such as biasingmember 136, for example, positioned intermediate the housing 132 and thetop clip 140 in the stack of clips 140. As described in greater detailbelow, the biasing member 136 can be configured to bias the bottom clip140 in the stack of clips 140 or, more particularly, the bottom face 146of the bottom clip 140, against the support shelves 135 defined in thehousing 132. The biasing member 136 can comprise a spring, and/or anysuitable compressed elastic element, for example, which can beconfigured to apply a biasing force to the clips 140, or at least applya biasing force to the top clip 140 which is transmitted downwardlythrough the stack of clips 140.

When a clip 140 is positioned against the support shelves 135 asdescribed above, the clip 140 can be supported in a firing position inwhich the clip 140 can be advanced and ejected from the cartridge 130.In various circumstances, the support shelves 135 can define at least aportion of a firing chamber 149 in which the clips 140 can besequentially positioned in the firing position. In some cases, thefiring chamber 149 can be entirely defined within the cartridge 130 or,in other cases, the firing chamber 149 can be defined within and/orbetween the shaft 110 and the cartridge 130. In any event, as describedin greater detail further below, the clip applier 100 can comprise afiring drive which can advance a firing member into the cartridge 130and push the clip 140 from its firing position positioned against thesupport shelves 135 to a fired position in which it is received withinthe end effector 120 of the clip applier 100. Referring primarily toFIGS. 288-290 , the housing 132 of the cartridge 130 can comprise aproximal opening, or window, 133 which can be aligned, or at leastsubstantially aligned, with the support shelves 135 such that the firingmember can enter into the cartridge 130 through the proximal opening 133and advance a clip 140 distally out of the cartridge 130. In at leastone such embodiment, the housing 132 can further comprise a distal, ordischarge, opening, or window, 137 which is also aligned with thesupport shelves 135 such that the clip 140 can be advanced, or fired,distally along a firing axis 139 extending through the proximal opening133, the firing chamber 149, and the distal opening 137, for example.

In order to advance a clip 140 out of the cartridge 130, further to theabove, the firing member of the firing drive can be advanced into to thecartridge housing 132 and, in various circumstances, into the firingchamber 149. As disclosed in greater detail further below, the firingmember can pass entirely through the cartridge 130 in order to advancethe clip 140 into its fired position within the end effector 120. Afterthe clip 140 positioned in the firing chamber 149 has been advanceddistally by the firing member, as outlined above, the firing member canbe retracted sufficiently such that the biasing member 136 can positionanother clip 140 against the support shelves 135. In variouscircumstances, the biasing member 136 can bias a clip 140 against thefiring member while the firing member is positioned within the housing132. Such a clip 140 can be referred to as a queued clip. After thefiring member has been sufficiently retracted and slid out fromunderneath the queued clip 140, the biasing member 136 can then bias theclip 140 against the support shelves 135 where it is staged for the nextstroke of the reciprocating firing member. Referring primarily to FIGS.276 and 288-290 , the cartridge 130 can be configured to supply theclips 140 to the firing chamber 149 along a predetermined path, such assupply axis 138, for example. The supply axis 138 can be transverse tothe firing axis 139 such that the clips 140 are fed into the firingchamber 149 in a direction which is different than the direction inwhich the firing member passes through the firing chamber 149. In atleast one such embodiment, the supply axis 138 can be perpendicular, orat least substantially perpendicular, to the firing axis 139, forexample.

Referring again to FIG. 276 , the shaft 110 can comprise a cartridge, ormagazine, aperture 131 which can be sized and configured to receive aclip cartridge 130, for example, therein. The cartridge aperture 131 canbe sized and configured such that the housing 132 of the cartridge 130is closely received within the cartridge aperture 131. The sidewallswhich define the cartridge aperture 131 can limit, or at leastsubstantially limit, the lateral movement of the cartridge 130 relativeto the shaft 110. The shaft 110 and/or the cartridge 130 can furthercomprise one or more locks which can be configured to releasably holdthe cartridge 130 in the cartridge aperture 131. As illustrated in FIG.276 , the cartridge 130 can be loaded into the cartridge aperture 131along an axis which is, in at least one embodiment, parallel to orcollinear with the supply axis 138. As also illustrated in FIG. 276 ,the shaft 110 can further comprise a pad or seat 118 extending from thesidewall 111 of the shaft 110 wherein the pad 118 can be configured tobe received within and/or engaged with the housing 132 of the cartridge130. The pad 118 can be sized and configured to be closely receivedwithin a recess 148 defined in the cartridge housing such that the pad118 can limit, or at least substantially limit, the lateral movement ofthe cartridge 130 relative to the shaft 110. The pad 118 can be sizedand configured to align the cartridge 130 within the shaft 110 and/orsupport the cartridge housing 132.

Once the clip cartridge 130 has been positioned and seated within theshaft aperture 131, referring now to FIGS. 279 and 280 , a firing drive160 of the clip applier 100 can be actuated to advance the clips 140from the clip cartridge 130 as described above. The firing drive 160 cancomprise a rotary drive input such as a drive screw 161, for example,and a displaceable firing nut 163 operably engaged with the drive screw161. The drive screw 161 can comprise at least one drive thread 162which can be threadably engaged with a threaded aperture extendingthrough the firing nut 163. In various embodiments, the clip applier 100can further include an electric motor, for example, operably coupledwith the drive screw 161. In various instances, the drive screw 161 canbe operably coupled with the motor of a surgical instrument systemcomprising a hand-held instrument or a robotic arm, for example. In anyevent, the movement of the firing nut 163 within the shaft 110 can beconstrained such that the firing nut 163 moves along a longitudinal axis164 when the drive screw 161 is rotated about the longitudinal axis 164by the motor. For instance, when the drive screw 161 is rotated in afirst direction by the motor, the drive screw 161 can advance the firingnut 163 distally toward the end effector 120, as illustrated in FIG. 280. When the drive screw 161 is rotated in a direction opposite the firstdirection by the motor, the drive screw 161 can retract the firing nut163 proximally away from the end effector 120. The shaft 110 cancomprise one or more bearings which can be configured to rotatablysupport the drive screw 161. For instance, a bearing 159 can beconfigured to rotatably support the distal end of the drive screw 161,for example, as illustrated in FIGS. 279 and 280 .

The firing drive 160 can further comprise a firing member 165 extendingfrom the firing nut 163 which can be advanced distally and retractedproximally with the firing nut 163, as described in greater detailfurther below. Upon comparing FIGS. 279 and 280 , the reader will notethat the firing nut 163 and the firing member 165 have been advancedfrom a proximal, unfired position, illustrated in FIG. 279 , to adistal, fired position, illustrated in FIG. 280 , in which the firingmember 165 has advanced a clip 140 from the clip cartridge 130 into theend effector 120. Referring primarily to FIG. 279 , the clip cartridge130 is illustrated as comprising a plurality of clips 140 stored thereinwherein one of the clips 140 is positioned in a firing position, asdescribed above. As illustrated in FIGS. 279 and 280 , the firing member165 can include a distal portion 166 which can be advanced into thestaple cartridge 130 along a firing axis 167 and engage the clip 140positioned in the firing position when the firing member 165 and thefiring nut 163 are advanced distally. In some cases, the firing member165 can comprise a linear member while, in other cases, the distal end166 of the firing member 165 can extend upwardly from the firing member165, for example. Further to the above, the firing member 165 canadvance the clip 140 distally out of the clip cartridge 130 along thefiring axis 167 and into a receiving cavity 122 defined in the endeffector 120.

In various cases, the firing member 165 can be attached to and extenddistally from the firing nut 163 while, in other cases, the firingmember 165 and the firing nut 163 can be operably connected to oneanother by a firing actuator 168. The firing actuator 168 can bepivotably mounted to the firing member 165 at a pivot 169 and caninclude a distal arm 170 a and a proximal arm 170 b which can be engagedwith a longitudinal slot 113 defined in the housing 112 of the shaft110. In at least one such embodiment, each of the arms 170 a, 170 b caninclude a projection, such as projections 171 a and 171 b, respectively,extending therefrom which can be configured to slide within thelongitudinal slot 113. Further to the above, the firing nut 163 canfurther include a firing pin 172 extending therefrom which can beconfigured to engage the distal arm 170 a in order to advance theactuator 168 and the firing member 165 distally, as described above. Inuse, referring again to the progression illustrated in FIGS. 279 and 280, the firing nut 163 can be advanced distally by the drive screw 161wherein the firing pin 172, which is positioned intermediate the distalarm 170 a and the proximal arm 170 b, can contact the distal arm 170 aand drive the actuator 168 and the firing member 165 distally. As theactuator 168 is advanced distally, the actuator 168 may be preventedfrom rotating about the pivot pin 169 as one or both of the projections171 a and 171 b sliding in the shaft slot 113 can be prevented frombeing moved laterally relative to the longitudinal shaft slot 113 untilthe actuator 168 reaches the position illustrated in FIG. 280 .

When the actuator 168 has reached the position illustrated in FIG. 280 ,the distal projection 171 a can enter into a distal slot portion 114 ofthe longitudinal slot 113 which can be configured to pivot the actuator168 downwardly, or permit the actuator 168 to be pivoted downwardly, asillustrated in FIG. 283 . In at least one such embodiment, the distalprojection 171 a can come into contact with the sidewall of the distalslot portion 114 which can guide the distal projection 171 a downwardlyand pivot the actuator 168 about the pivot 169 as the actuator 168 isadvanced forward by the firing nut 163. In such a pivoted position, thefiring pin 172 extending from the firing nut 163 may no longer beengaged with the distal arm 170 a of the actuator 168 wherein,subsequently, the firing nut 163 may move distally independently of theactuator 168 thereby leaving behind the actuator 168 and the firingmember 165. Stated another way, the distal end 114 of the longitudinalshaft slot 113 may deactivate the firing member 165 wherein, at suchpoint, the position of the firing member 165 may represent thefully-fired or distal-most position of the firing member 165. In such aposition, the clip 140 has been fully advanced into the receivingcavity, or receiver, 122. Furthermore, in such a position, the next clip140 to be advanced into the receiving cavity 122 may be biased againstthe top surface of the firing member 165, further to the above.

Once a clip 140 has been positioned within the receiving cavity 122,further to the above, the clip 140 can be deformed by a crimping drive180, for example. Referring now to FIGS. 277 and 278 , the end effector120 of the clip applier 100 can further comprise a first jaw 123 a and asecond jaw 123 b wherein the first jaw 123 a and the second jaw 123 bcan at least partially define the receiving chamber 122. As illustratedin FIGS. 277 and 278 , the first jaw 123 a can comprise a first channel124 a and the second jaw 123 b can comprise a second channel 124 b whichcan each be configured to receive and support at least a portion of aclip 140 therein. The first jaw 123 a can be pivotably coupled to aframe 111 of the shaft 110 by a pin 125 a and the second jaw 123 b canbe pivotably coupled to the frame 111 by a pin 125 b. In use, thecrimping drive 180 can be configured to rotate the first jaw 123 atoward the second jaw 123 b and/or rotate the second jaw 123 b towardthe first jaw 123 a in order to compress the clip 140 positionedtherebetween. In at least one such embodiment, the crimping drive 180can comprise a cam actuator 181 which can be configured to engage afirst cam surface 126 a defined on the first jaw 123 a and a second camsurface 126 b on the second jaw 123 b in order to pivot the first jaw123 a and the second jaw 123 b toward one another. The cam actuator 181can comprise a collar which at least partially surrounds the first jaw123 a and the second jaw 123 b. In at least one such embodiment, thecollar can comprise an inner cam surface 182 which can be contoured tocontact the cam surfaces 126 a, 126 b of the jaws 123 a, 123 b and drivethem inwardly toward one another. In various circumstances, the clip 140positioned within the receiving chamber 122 defined in the end effector120 can be positioned relative to tissue before the crimping drive 180is actuated. In some circumstances, the crimping drive 180 can be atleast partially actuated prior to positioning the clip 140 relative tothe tissue in order to at least partially compress the clip 140. Incertain instances, the clip 140 and the receiving chamber 122 can besized and configured such that the clip 140 can be biased or flexedinwardly when the end effector 120 is in its unactuated state, asillustrated in FIG. 277 . In various instances, the crimping first jaw123 a and the second jaw 123 b can be actuated to elastically crimpand/or permanently crimp the clip 140 positioned therebetween.

Further to the above, the firing nut 163 can be configured to actuatethe crimping drive 180. More particularly, referring now to FIG. 281 ,the crimping drive 180 can comprise a crimping actuator 188 operablycoupled with the cam actuator 181 wherein the crimping actuator 188 canbe selectively engaged by the firing nut 163 as the firing nut 163 isadvanced distally as described above. In at least one such embodiment,the firing nut 163 can further comprise a second firing pin, such asfiring pin 184, for example, extending therefrom which can be configuredto engage the crimping actuator 188 as the firing nut 163 is advancingthe firing actuator 168. Referring again to FIG. 281 , the crimpingactuator 188 is positioned in an unactuated position and, when thefiring nut 163 is advanced sufficiently to engage a distal arm 190 a ofthe crimping actuator 188, the firing nut 163 can rotate the crimpingactuator 188 upwardly into an actuated position as illustrated in FIG.282 . As also illustrated in FIG. 282 , the distal arm 190 a and aproximal arm 190 b can each comprise a projection, such as projections191 a and 191 b, respectively, extending therefrom which can bepositioned within a second longitudinal slot defined in shaft 110, suchas slot 115, for example. As the crimping actuator 188 is rotatedupwardly from its unactuated position about a pivot 189, the projections191 a and 191 b can move from the proximal curved end 116 of thelongitudinal slot 115 into a portion of the longitudinal slot 115 whichis substantially linear. Similar to the above, the sidewalls of thelongitudinal slot 115 can be configured to confine the movement of thecrimping actuator 188 along a longitudinal path and can be configured tolimit or prevent the rotation of the crimping actuator 188 once thecrimping actuator 188 has been rotated upwardly into an at leastpartially actuated position, as discussed above. As the reader willunderstand, the firing pin 172 of the firing drive 160 and the firingpin 184 of the crimping drive 180 both extend from the firing nut 163.For the sake of expediency and demonstration, the firing pins 172 and184 are illustrated as extending from the same side of the firing nut163; however, it is envisioned that the firing pin 172 can extend from afirst lateral side of the firing nut 163 while the firing pin 184 canextend from the other lateral side of the firing nut 163. In suchcircumstances, the firing actuator 168 can be positioned alongside thefirst lateral side of the drive screw 161 and the crimping actuator 188can be positioned alongside the opposite lateral side of the drive screw161. Correspondingly, the longitudinal slot 113 can be defined in afirst lateral side of the shaft housing 112 while the longitudinal slot115 can be defined in the opposite lateral side of the shaft housing112.

Further to the above, the cam actuator 181 can be operably coupled withcrimping actuator 188 such that, when the crimping actuator 188 isadvanced distally by the firing nut 163, the cam actuator 181 can beadvanced distally, as illustrated in FIGS. 282 and 284 , until thedistal projection 191 a extending from the distal arm 190 a reaches thedistal end 117 of the longitudinal slot 115. In such a distal position,the cam actuator 181 may be in a fully advanced position and the clip140 positioned within the receiving chamber 122 can be in a fullydeformed or crimped configuration. Thereafter, the cam actuator 181 canbe retracted and the end effector 120 can be reopened. Moreparticularly, the drive screw 161 can be rotated in an oppositedirection in order to move the firing nut 163 proximally and retract thecam actuator 181 wherein, in certain instances, the end effector 120 canfurther include a biasing member which can be configured to bias thefirst jaw 123 and the second jaw 123 b from the closed, or fired,position illustrated in FIG. 278 into the open, or unfired, positionillustrated in FIG. 277 . As the firing nut 163 is retracted from itsposition illustrated in FIG. 284 , the firing pin 184 extending from thefiring nut 163 can engage the proximal arm 190 b of the crimpingactuator 188 and move the crimping actuator 188, and the cam actuator181 extending therefrom, proximally as illustrated in FIG. 286 . Similarto the above, the proximal projection 191 b extending from the proximalarm 190 b of the crimping actuator 188 can be configured to contact thesidewall of the curved proximal end 116 wherein the sidewall can guidethe crimping actuator 188 downwardly and rotate the crimping actuator188 about the pivot 189. At such point, the firing pin 184 may no longerbe engaged with the crimping actuator 188, the cam actuator 181 may befully retracted, and the firing nut 163 may continue to be retractedproximally relative to the crimping actuator 188.

Further to the above, referring now to FIG. 285 , the firing nut 163 canbe configured to re-engage the firing actuator 168 as the firing nut 163is being retracted proximally. As discussed above, the firing actuator168 is rotated downwardly when the firing actuator 168 reaches thedistal end 114 of the longitudinal slot 113 and, as a result, the firingactuator 168 may still be in its downwardly rotated position when thefiring nut 163 is retracted proximally to re-engage the firing actuator168. As illustrated in FIG. 285 , the firing pin 172 extending from thefiring nut 163 can engage the proximal arm 170 b of the firing actuator168 and, as the firing nut 163 is further retracted, the firing nut 163can rotate the firing actuator 168 upwardly such that the projections171 a and 171 b extending from the arms 170 a and 170 b, respectively,can re-enter the longitudinal portion of the longitudinal slot 113.Thereafter, the firing nut 163 and can be retracted until the firingactuator 168 and the firing member 165 extending therefrom have beenreturned to their starting, or unfired, positions illustrated in FIG.279 . In such circumstances, the firing member 165 can be withdrawn fromthe clip cartridge 130 as the firing member 165 is retracted proximallyby the firing nut 163 such that a new clip 140 can be biased into thefiring chamber of the clip cartridge 130 by the biasing member 136. Oncethe firing member 165 and the firing actuator 168 have been retracted totheir starting positions and the next clip 140 has been positionedwithin the firing chamber, the firing drive 160 can be actuated onceagain in order to move the firing nut 163 and the firing member 165distally to advance the next clip 140 into the end effector 120.Likewise, the firing nut 163 can re-actuate the crimping drive 180 asthe firing nut 163 is moved distally once again in order to deform thenext clip 140. Thereafter, the firing nut 163 can retracted in order tore-set the crimping drive 180 and the firing drive 160 once again. Thisprocess can be repeated until a sufficient number of clips 140 have beenapplied to the targeted tissue and/or until the clips 140 containedwithin the clip cartridge 130 have been depleted. In the event thatadditional clips 140 are needed, the expended clip cartridge 130 can beremoved from the shaft 110 and a replacement clip cartridge 130containing additional clips 140 can be inserted into the shaft 110. Insome circumstances, an at least partially depleted clip cartridge 130can be replaced with an identical, or at least nearly identical,replacement clip cartridge 130 while, in other circumstances, the clipcartridge 130 can be replaced with a clip cartridge having more than orless than five clips 140 contained therein and/or a clip cartridgehaving clips other than clips 140 contained therein, for example.

Referring again to FIGS. 280-283 , the firing nut 163 of the illustratedembodiment can be configured to become disengaged from the firingactuator 168 at the same time that the firing nut 163 becomes engagedwith the crimping actuator 188. Stated another way, the firing drive 160can be deactivated at the same time that the crimping drive 180 isactivated. In various circumstances, such timing can be achieved whenthe distal end 114 of the longitudinal slot 113 is aligned, or at leastsubstantially aligned, with the proximal end 116 of the secondlongitudinal slot 115, for example. In the illustrated embodiment and/orany other suitable embodiment, a lag can exist between the deactivationof the firing drive 160 and the activation of the crimping drive 180.Such a lag between the end of the firing stroke of the firing member 165and the beginning of the firing stroke of the cam actuator 181 can becreated, in some circumstances, to assure that the clip 140 has beenpositioned in its fully-seated position within the receiving chamber 122before the clip 140 is deformed by the cam actuator 181. In variouscircumstances, such a lag can be created when the distal end 114 of thelongitudinal slot 113 is positioned proximally with respect to theproximal end 116 of the second longitudinal slot 115, for example. Inthe illustrated embodiment and/or any other suitable embodiment, thedeactivation of the firing drive 160 may occur after the activation ofthe crimping drive 180. Such an overlap between the end of the firingstroke of the firing member 165 and the beginning of the firing strokeof the cam actuator 181 can be created, in some circumstances, to applyat least some inward pressure on the clip 140 as it is moved into itsfully-seated position within the receiving chamber 122 so as to reduceor eliminate relative movement between the clip 140 and the sidewalls ofthe receiving chamber 122, for example. In various circumstances, suchan overlap can be created when the distal end 114 of the longitudinalslot 113 is positioned distally with respect to the proximal end 116 ofthe second longitudinal slot 115, for example.

In the illustrated embodiment of FIG. 275 and/or any other suitableembodiment, turning now to FIG. 291 , a clip cartridge, such as clipcartridge 230, for example, can comprise a pusher plate 248 positionedintermediate the biasing member 136 and the top-most clip 140 stackedwithin the clip cartridge 230. The pusher plate 248 can be rigid, or atleast substantially rigid, and can comprise a first bearing surfaceagainst which the biasing member 136 can apply a biasing force. Thepusher plate 248 can also comprise a second bearing surface which cantransmit the biasing force to the top surface 145 of the top-most clip140. The pusher plate 248 can be comprised of a sheet of stainless steelmaterial, for example, although the pusher plate 248 can comprise anysuitable shape and can be comprised of any suitable material. In certaininstances, the pusher plate 248 may not be attached to the biasingmember 136 while, in other instances, the pusher plate 248 can beaffixed to the biasing member 136 such that the pusher plate 248 doesnot become dislodged from the cartridge housing 132. In variouscircumstances, the pusher plate 248 can be sized and configured suchthat it cannot pass through the proximal opening 133 and/or the distalopening 137 defined in the cartridge housing 132.

In the illustrated embodiment of FIG. 275 and/or any other suitableembodiment, turning now to FIGS. 292 and 293 , a clip cartridge, such asclip cartridge 330, for example, can comprise a lockout member which canbe positioned within the firing chamber 149 of the clip cartridge 330after all of the clips 140 contained within the clip cartridge 330 havebeen ejected from the cartridge 330. The lockout member can comprise alockout plate 348 which can be positioned intermediate the biasingmember 136 and the top surface 145 of the top-most clip 140 containedwithin the clip cartridge 330. In use, further to the above, the clips140 can be sequentially positioned in the firing chamber 149 of the clipcartridge 130 and then advanced distally out of the clip housing 132wherein, after the last clip 140 has been advanced out of the cliphousing 132 and the firing member 165 has been withdrawn from the clipcartridge 130, the biasing member 136 can bias the lockout plate 348against the shelves 135. In such a position, the lockout plate 348 canbe aligned with the proximal opening 133 and the distal opening 137 suchthat the firing member 165 cannot enter, or at least substantiallyenter, the clip cartridge 130. In such circumstances, the lockout plate348 can block the firing member 165 from entering into and passingthrough the housing 132 and, as a result, prevent the inadvertent firingof the clip applier 100 after the clip cartridge 130 has run out ofclips. In the event that the operator of the clip applier 100 were toactuate the firing drive 160 and attempt to advance the firing member165 into the spent clip cartridge 130, the firing member 165 wouldcontact and abut the lockout plate 348 wherein, in such circumstances, acompressive load can be created within the firing member 165. The clipapplier 100 can further include a clutch which can be configured to slipand operably disconnect the motor from the drive screw 161 when thecompressive load created within the firing member 165 exceeds a certainor predetermined amount. In addition to or in lieu of a clutch, themotor and/or motor controller of the clip applier 100 which operates thefiring drive 160, for example, can comprise a load sensor configured todetect the load generated within the firing member 165 and, when theload created within the firing member 165 exceeds a certain orpredetermined amount, the voltage and/or current supplied to the motorcan be switched off and/or reduced. In any event, the lockout plate 348can be sized and configured such that the lockout plate 348 cannot bedislodged through the distal opening 137 and/or the proximal opening 133when the firing member 165 contacts the lockout plate 348. In order touse the clip applier 100 once again, the operator of the clip applier100 can remove the spent cartridge 330 from the shaft 110 and insert anew clip cartridge 330, for example, into the shaft 110. At such point,a clip 140 may be positioned within the firing chamber 149 of the newclip cartridge 330 and the firing member 165 can be advanced distallyinto the new clip cartridge 330 to deploy the clip 140 as describedabove.

In the illustrated embodiment of FIG. 275 and/or any other suitableembodiment, referring now to FIGS. 294 and 295 , a clip cartridge, suchas clip cartridge 430, for example, can comprise guides which can beconfigured to limit or confine the movement of a lockout member withinthe clip cartridge 430. Similar to the above, the lockout member cancomprise a lockout plate 448, for example, which can be positionedintermediate the biasing member 136 and the top surface 145 of thetop-most clip 140 contained within the housing 432 of the clip cartridge430. In use, similar to the above, the lockout plate 448 can beprogressively pushed downwardly into the firing chamber 149 as the clips140 are sequentially ejected from the clip cartridge 430. The lockoutplate 448 can be sized and configured such that it is closely receivedwithin the cartridge housing 432 and such that relative lateral movementbetween the lockout plate 448 and the housing 432 can be limited inorder to reduce, or prevent, the possibility of the lockout plate 448becoming misaligned within the clip cartridge 430. In the event that thelockout plate 448 were to become misaligned within the clip cartridge430, the lockout plate 448 may bind within the housing 432 and preventthe biasing member 136 from applying an appropriate biasing force to thestack of clips 140, for example. As illustrated in FIGS. 294 and 295 ,the lockout plate 438 can further comprise guide members 447 extendingtherefrom which can be received within guide slots 446 defined in thecartridge housing 432. The guide members 447 and the guide slots 446 canbe sized and configured such that the guide members 447 are closelyreceived within the guide slots 446 and such that relative lateralmovement between the lockout plate 438 and the cartridge housing 432 canbe limited. Each of the guide slots 446 can be defined by opposingsidewalls 445 which can define a distance therebetween which is equal toor slightly larger than the width of the guide member 447 positionedtherein such that the guide member 447 can slide between the opposingsidewalls 445 between the top 443 and the bottom 444 of the guide slot446. Thus, while the guide members 447 and the guide slots 446 can beconfigured to limit lateral movement therebetween, as outlined above,the guide members 447 and the guide slots 446 can be configured topermit relative movement between the lockout plate 438 and the cartridgehousing 432 along a predetermined path parallel to or collinear with thesupply axis 138, for example. When the lockout plate 438 is pushed intothe firing chamber 149 by the biasing member 136, the lockout plate 438can inhibit the advancement of the firing member 165 and the operationof the clip applier 100, as outlined above, until the spent clipcartridge 430 is replaced with another suitable clip cartridge.

In the illustrated embodiment of FIG. 275 and/or any other suitableembodiment, as discussed above, the drive screw 161 can be rotated in afirst direction to advance the firing nut 163 distally and rotated in asecond, or reverse, direction to retract the firing nut 163 proximally.In order to rotate the drive screw 161 in the first and seconddirections, the electric motor operably coupled with the drive screw 161can be operated in corresponding first and second directions. In theillustrated embodiment of FIG. 275 and/or any other suitable embodiment,a clip applier can utilize a motor which is operated in only a firstdirection wherein the rotation of the motor in such a single directioncan be utilized to advance a firing nut distally and retract the firingnut proximally. Turning now to FIGS. 296-300 , the output of an electricmotor can be transmitted to a drive system 560 via a transmission system550. The transmission system 550 can comprise an input shaft 552 whichis operated in a single direction wherein the transmission system 550can be switchable or shiftable between a first state, or configuration,in which the transmission system 550 rotates a drive screw 561 of thedrive system 560 in a first direction and a second state, ofconfiguration, in which the transmission system 550 rotates the drivescrew 561 in a second, or opposite, direction. The first state of thetransmission system 550 is depicted in FIGS. 296-298 and the secondstate of the transmission system 550 is depicted in FIGS. 299 and 300 .

Referring again to FIGS. 296-298 , the input shaft 552 can comprise aninput gear 551 mounted thereto which is operably coupled, or meshinglyengaged, with a shifter gear 553 such that the rotation of the inputshaft 552 is transmitted to the shifter gear 553. With regard to all ofthe gears discussed herein, gears which are operably coupled ormeshingly engaged with one another can comprise any suitable arrangementof teeth, for example, which can transmit the rotation of one gear tothe other. When the input shaft 552 is rotated in the first direction,the shifter gear 553 is rotated in the second, or opposite, direction.In the first state of the transmission system, the shifter gear 553 isin a first position in which the shifter gear 553 is operably coupledwith an intermediate gear 554 wherein, when the shifter gear 553 isrotated in the second direction by the input gear 551, as discussedabove, the intermediate gear 554 is rotated in the first direction.Although not illustrated, the intermediate gear 554 can be rotatablysupported within the shaft 110 of the clip applier 100, for example. Theintermediate gear 554 can also be operably coupled with an output gear555 mounted to the drive screw 561 such that the rotation of theintermediate gear 554 can be transmitted to the output gear 555. Whenthe intermediate gear 554 is driven in the first direction by theshifter gear 553, as described above, the intermediate gear 554 candrive the output gear 555 and the drive screw 561 in the seconddirection. Similar to the above, the firing nut 563 can be operablycoupled with the drive screw 561 and suitably constrained within theshaft 110 such that, when the drive screw 561 is rotated in the seconddirection, the firing nut 563 is advanced distally as indicated by thearrow D.

Similar to the above, the firing nut 563 can be advanced to itsdistal-most position, illustrated in FIG. 298 , in order to advance aclip 140 from the clip cartridge 130 into the end effector 120 and crimpthe clip 140 as described above. As illustrated in FIGS. 297 and 298 ,the firing nut 563 can further comprise a cam bar 569 extendingtherefrom which can be configured to shift the transmission system 550from its first state to its second state. Upon comparing FIG. 298 andFIG. 299 , the reader will note that the shifter gear 553 is movablebetween a first position in which the transmission system 550 is in itsfirst state and a second position in which the transmission system 550is in its second state. More particularly, the shifter gear 553 ismounted to a shifter 556 which is rotatable about the input shaft 552such that the shifter gear 553 can be rotated from its first position inwhich the shifter gear 553 is operably engaged with the input gear 551and the intermediate gear 554 and its second position in which theshifter gear 553 is operably disengaged from the intermediate gear 554.Although the shifter gear 553 is operably disengaged from theintermediate gear 554 when the shifter gear 553 is in its secondposition, the shifter gear 553 can be operably coupled with the inputgear 551 and the output gear 555 in order to transmit rotary motion fromthe input shaft 552 to the drive screw 561. As illustrated in FIGS. 298and 299 , the shifter 556 can comprise a central aperture through whichthe input shaft 552 can extend; however, the shifter 556 may not beoperably engaged with the input shaft 552 and, as a result, the rotationof the input shaft 552 may not rotate the shifter 556 and, likewise, therotation of the shifter 556 may not rotate the input shaft 552. In anyevent, the shifter 556 can further comprise a cam follower 558 extendingtherefrom which can be engaged by a cam 568 defined on the cam bar 569as the firing nut 563 is advanced distally. When the cam 568 engages thecam follower 558, the cam 568 can rotate the shifter 556 and the shiftergear 553 between its first position and its second position as describedabove.

When the shifter gear 553 is in its second position and the transmissionsystem 550 is in its second state, as described above, the input shaft552 and the drive screw 561 can both be rotated in the first direction.More particularly, the input shaft 552, when rotated in the firstdirection, can rotate the input gear 551 in the first direction and, asthe shifter gear 553 is directly engaged with the input gear 551, theshifter gear 553 will be rotated in the second direction. The readerwill note that the shifter gear 553 rotates in the second direction whenthe transmission system 550 is in its second state as compared to thefirst, or opposite, direction when the transmission system 550 is in itsfirst state. Upon comparing FIGS. 298 and 299 , further to the above,the reader will appreciate that the intermediate gear 554 is no longeroperably positioned intermediate the input gear 551 and the shifter gear553 when the transmission system 550 is in its second state therebyaccounting for the different directions of rotation. As the shifter gear553 is operably engaged with the input gear 551 and the output gear 555when the shifter gear 553 is in its second position, the shifter gear553 can rotate the output gear 555, and the drive screw 561 coupled tothe output gear 555, in the first direction. When the drive screw 561 isrotated in the first direction, as illustrated in FIGS. 299 and 300 ,the firing nut 563 can be retracted proximally to permit the endeffector 120 to be reopened and to retract the firing member 165.Referring primarily to FIG. 300 , the firing nut 563 can furthercomprise a second cam bar 567 extending therefrom comprising a cam 566which can be configured to contact the cam follower 558 of the shifter556 as the firing nut 563 is retracted proximally into itsfully-retracted position. In such circumstances, the cam 566 can pushthe shifter 556 back into its first position and into operativeengagement with the intermediate gear 554 such that the transmissionsystem 550 can be reset into its first state and the clip applier 100can be actuated once again.

As discussed above, the firing drive of the clip applier 100 can beoperated by a surgical instrument system comprising an electric motor. Arobotic surgical instrument system 20 is illustrated in FIG. 301 and cancomprise a plurality of movable arms 30. Each arm 30 can comprise anactuator module 32 comprising an electric motor configured to supply therotary motion to the shaft 110 of a clip applier 100, and/or any othersuitable surgical instrument. Referring now to FIG. 302 , an endeffector 620 may be selectively engageable with and disengageable froman actuator shaft 610 of a clip applier wherein the end effector 620 cancomprise a proximal end 621 which can be coupled to a distal end 611 ofthe shaft 610. The proximal end 621 of the end effector 620 can comprisean outer housing 629, a frame extending through the outer housing 629,an outer drive shaft extending through the frame, and an inner driveshaft extending through the outer drive shaft. Similarly, the distal end611 of the shaft 610 can comprise an outer housing 619, a frame 663extending through the outer housing 619, an outer drive shaft 662extending through the frame 663, and an inner drive shaft 661 extendingthrough the outer drive shaft 662. With regard to the distal end 611 ofthe shaft 610, the frame 663, the outer drive shaft 662, and the innerdrive shaft 661 can each comprise a portion of a tongue connector 613extending therefrom and a portion of a connector groove 612 definedtherein, wherein the tongue connector 613 can be configured to bereceived within a tongue groove 623 defined in the proximal end 621 ofthe end effector 620, and wherein the tongue groove 612 can beconfigured to receive a tongue connector 622 extending from the proximalend 621 of the end effector 620. Similar to the tongue connector 613which extends across the frame 663, the outer drive shaft 662, and theinner drive shaft 661 of the distal shaft end 611, the tongue connector622 can extend across the frame, the outer drive shaft, and the innerdrive shaft of the proximal end 621 of the end effector 620. Also,similar to the tongue groove 612 which extends across the frame 663, theouter drive shaft 662, and the inner drive shaft 661 of the distal shaftend 611, the tongue groove 623 can extend across the frame, the outerdrive shaft, and the inner drive shaft of the proximal end 621 of theend effector 620. In the configuration depicted in FIG. 302 , the tongueconnector 622 of the end effector 620 can be slid laterally into thetongue groove 612 of the shaft 610 at the same time that the tongueconnector 613 of the shaft 610 is slid laterally into the tongue groove623 of the end effector 620. Owing to such assembly, the frame of theend effector 620 can be securely coupled to the frame 663 of the shaft610, the outer drive shaft of the end effector 620 can be operablycoupled to the outer drive shaft 662 of the shaft 110, and the innerdrive shaft of the end effector 620 can be operable coupled to the innerdrive shaft 661 of the shaft 110. The reader will note that the portionsof the tongue connector 612 are aligned with one another, the portionsof the tongue groove 613 are aligned with one another, the portions ofthe tongue groove 622 are aligned with one another, and the portions ofthe tongue connector 623 are aligned with one another when the endeffector 620 is assembled to the shaft 610. Once assembled, the outerdrive shaft 662 of the shaft 110 can rotate the outer drive shaft of theend effector 620, and the inner drive shaft 661 of the shaft 610 canrotate the inner drive shaft of the end effector 620. When the outerdrive shaft 662 and/or the inner drive shaft 661 are rotated, theportions of the tongue connector 612, the portions of the tongue groove613, the portions of the tongue groove 622, and the portions of thetongue connector 623 may no longer be aligned. In order to remove theend effector 620 from the shaft 610, the inner drive shaft 661 and/orthe outer drive shaft 662 can be rotated into one or more positions inwhich the tongue connectors 612 and 623 and the tongue grooves 613 and622 are sufficiently aligned.

Referring again to FIG. 302 , the outer housing 619 of the shaft 610 canfurther comprise a stop 614 which can be configured to limit the lateralmovement of the end effector 620 as the end effector 620 is being slidtransversely onto the distal end 611 of the shaft 610. The stop 614 canprovide a datum from which the inner drive shaft of the end effector 620and the inner drive shaft 661 of the shaft 610 are aligned alonglongitudinal axis 615, the outer drive shaft of the end effector 620 andthe other drive shaft 662 of the shaft 610 are aligned alonglongitudinal axis 615, and/or the frame of the end effector 620 and theframe 663 of the shaft 610 are aligned along the longitudinal axis 615.Further to the above, the inner drive shaft 661 can extend into anactuator module 632 which can comprise an electric motor and/or geartrain 664 operably coupled with the inner drive shaft 661 configured torotate the inner drive shaft 661. Furthermore, the actuator module 632can comprise a second electric motor and gear train operably engagedwith the second drive shaft 662 configured to drive the second driveshaft 662. As described in greater detail below, a second electric motorcan be utilized to articulate the end effector 620. Also, further to theabove, the outer housing 619 and/or the frame 663 of the shaft 610 canfurther comprise a gear 617 mounted thereto which is operably engagedwith an electric motor and gear train 618 which can be configured torotate the shaft 610 and the end effector 620 about the longitudinalaxis 615. For instance, if the electric motor and gear train 618 areoperated in a first direction, the shaft 610 and the end effector 620can be rotated about the axis 615 in a clockwise direction while, if theelectric motor and gear train 618 are operated in a second direction,the shaft 610 and the end effector 620 can be rotated about the axis 615in a counter-clockwise direction in order to position and orient the endeffector 620.

As discussed above, the end effector 620 can be selectively attached toand detached from the shaft 610. The reader will note that theprinciples discussed in connection with the end effector 620 and shaft610 can be equally applied to the end effector 120 and the shaft 110 ofthe embodiment disclosed in FIG. 275 , among others. That said,referring again to FIG. 301 , one of the robotic arms 30 can beselectively engaged with an end effector 120 of a clip applier or,alternatively, any other suitable end effector, such as the end effectorof a surgical stapler, for example. In such circumstances, an endeffector 120 can be selectively interchanged with another end effectorand, as a result, a single robotic arm 30 can be utilized to performmore than one function. Stated another way, the clip applier 100 cancomprise a replaceable loading unit which can be replaced by, orinterchanged with, another clip applier loading unit and/or any othersuitable replaceable loading unit. Turning now to FIG. 303 , the endeffector 120 and the shaft 110 of the clip applier 100 can be utilizedwith a surgical instrument system comprising a handle 700. The handle700 can comprise an actuator 701 which can be operated, or squeezedtoward grip 702, in order to apply a rotary motion to the drive screw161 as described above. In some cases, the rotation of the actuator 701can be mechanically transmitted to the drive screw 161 while, in othercases, the actuator 701 can operate a motor operably coupled to thedrive screw 161.

Further to the above, the end effector 120 and the shaft 110 of the clipapplier 100 can be aligned along a longitudinal axis of the clip applier100. Turning now to FIG. 304 , the end effector 120 and/or the shaft 110can further comprise an articulation joint 101 which can be configuredto permit the end effector 120 to be articulated relative to thelongitudinal axis of the clip applier 100. The shaft 110 can comprise anouter housing, or frame portion, 119 which can comprise a proximal end102 and can comprise a distal portion of the articulation joint 101. Theproximal end 102 can comprise a spherical, or an at least substantiallyspherical, end 102, for example, which can be received within aspherical, or an at least substantially spherical, cavity 104 defined inan articulation joint member 103. The articulation joint member 103 canalso comprise a spherical, or at least substantially spherical, end 105,for example, which can be received within a spherical, or an at leastsubstantially spherical, cavity 107 defined in a shaft frame portion106. The proximal end 102 of the shaft 110 can be at least partiallycaptured within the cavity 104 such that the proximal end 102 cannot bereadily removed from the cavity 104. That said, the proximal end 102 andthe cavity 104 can be sized and configured to permit the proximal end102 to be rotated in any suitable direction within the cavity 104. Asalso illustrated in FIG. 304 , the clip applier 100 can further comprisearticulation controls 108 a and 108 b, for example, which can extendthrough the articulation joint 101 and can comprise distal ends mountedwithin mounting apertures 109 a and 109 b, respectively, defined withinthe proximal end 102 of the shaft housing 119. In use, the articulationcontrols 108 a and 108 b can be pushed and/or pulled in order to movethe proximal end 102 within the cavity 104. Further to the above, theend 105 of the articulation joint member 103 can be at least partiallycaptured within the cavity 107 defined in the shaft frame portion 106such that the end 105 cannot be readily removed from the cavity 107.That said, the end 105 and the cavity 107 can be sized and configured topermit the end 105 to be rotated in any suitable direction within thecavity 107 when the shaft end 102 is pushed and/or pulled by theactuators 108 a and 108 b as described above.

Further to the above, referring again to FIG. 304 , the drive screw 161can be rotated by an input shaft, such as input shaft 152, for example.The input shaft 152 can extend through an aperture 156 defined withinthe shaft frame portion 106, the articulation joint member 103, and theproximal end 102 of the shaft housing 119. The input shaft 152 cancomprise an input gear 151 mounted to the distal end thereof which canbe operably coupled with an output gear 155 mounted to the proximal endof the drive screw 161. In use, the input shaft 152 can be rotated bythe electric motor, described above, wherein the input shaft 152 canrotate the drive screw 161. As outlined above, the articulation joint101 can be configured to permit the end effector 120 and at least aportion of the shaft 110 to be articulated relative to a longitudinalaxis defined by the clip applier 100. In order to accommodate suchmovement, at least the portion of the input shaft 152 extending throughthe articulation joint 101 can be sufficiently flexible.

Turning now to FIGS. 305-308 , the articulation actuators 108 a and 108b can be operated by an actuator module such as module 832, for example.Referring primarily to FIG. 305 , the actuator module 832 can comprise arotatable articulation driver 833 which can be configured to push andpull the articulation actuators 108 a and 108 b. The articulation driver833 can comprise a cylindrical, or an at least substantiallycylindrical, collar 835 including an aperture 837 which can beconfigured to receive at least a portion of the shaft frame 106 thereinin order to rotatably support the collar 835. The articulation driver833 can further comprise an input gear portion 834 which can be operablycoupled with an electric motor and gear train 831 of the module 832wherein, when the electric motor and gear train 831 are actuated, thearticulation driver 833 can be rotated about the shaft frame 106.Referring primarily to FIGS. 306 and 308 , the articulation driver 833can further comprise two cam slots defined in the sidewall of the collaraperture 837, although the reader will note that only one cam slot 835 ais illustrated in the provided views. The cam slot 835 a is configuredto receive a cam follower 838 a extending from the articulation driver108 a wherein the cam follower 838 a is configured to slide within thecam slot 835 a. When the articulation driver 833 is rotated, the helicalcontour of the cam slot 835 a, for example, can be configured to pushthe cam follower 838 a distally or pull the cam follower 838 aproximally, depending on the direction in which the articulation driver833 is rotated. As a result of the proximal or distal movement of thecam follower 838 a, the cam actuator 108 a can be moved proximally ordistally, respectively. While not illustrated, the articulation driver108 b can comprise a cam follower, similar to the cam follower 838 a,which can be configured to slide within the other cam slot discussedabove. The other cam slot can be configured such that, when thearticulation actuator 108 a is driven distally by the articulationdriver 833 when the articulation driver 833 is rotated in a firstdirection, the articulation actuator 108 b can be pulled proximally.Similarly, the other cam slot can be configured such that, when thearticulation actuator 108 a is pulled proximally by the articulationdriver 833 when the articulation driver 833 is rotated in a seconddirection, the articulation actuator 108 b can be driven distally.Referring primarily to FIG. 306 , the shaft frame portion 106 cancomprise clearance slots 839 defined therein through which the camfollowers can extend. Although the above features have been discussed inconnection with an actuator module 832, such features could be used inconnection with the other actuator modules disclosed herein.

FIGS. 309, 310, and 311 depict a clip applier 70100 in accordance withat least one embodiment. The clip applier 70100 is similar to the clipapplier 100 in many respects, most of which will not be repeated hereinfor the sake of brevity. Similar to the clip applier 100, the clipapplier 70100 comprises an end effector 70120, a shaft, a clipcartridge, and a firing member 70165. The clip cartridge comprises aplurality of clips 70140 removably stored therein. The end effector70120 comprise a first jaw 70123 a and a second jaw 70123 b wherein thefirst jaw 70123 a and the second jaw 70123 b at least partially define areceiving chamber 70122. Further, the first jaw 70123 a and the secondjaw 70123 b are pivotally coupled to the shaft by a pin 70125 such thatthe first jaw 70123 a and the second jaw 70123 b are movable relative toeach other between an open position (FIG. 310 ) and a closed position(FIG. 309 ). The first jaw 70123 a and the second jaw 70123 b aremovable between the open position and the closed position by a crimpingdrive 70180 (see FIGS. 312-314 ). Other embodiments are envisioned wherethe first jaw 70123 a and the second jaw 70123 b are pivotally coupledto the shaft utilizing at least one pin similar to the first jaw 125 aand second jaw 125 b depicted in FIG. 275 . The first jaw 70123 a andthe second jaw 70123 b include pre-form features, such as protrusions70126 a and 70126 b which are discussed in further detail below.

In use, the firing member 70165 advances a clip 70140 from the clipcartridge onto the protrusions 70126 a and 70126 b as depicted in FIG.309 . In this position, the clip 70140 is in a pre-formed configuration.The width of the clip 70140 in the pre-formed configuration can be0.080″ preferably. When the first jaw 70123 a and the second jaw 70123 bare moved from the closed position to the open position, the protrusions70126 a and 70126 b expand the clip 70140 to an expanded configurationas depicted in FIG. 310 . The width of the clip 70140 in the expandedconfiguration can be 0.210″ preferably. During the transition of theclip 70140 from the pre-formed configuration to the expandedconfiguration, the firing member 70165 supports the backside of the clip70140. More specifically, the firing member 70165 includes angledsurfaces 70165 a and 70165 b which provide support for the backside ofthe clip 70140 as the clip 70140 expands. Further, as the clip 70140 isexpanded, the firing member 70165 can be advanced to allow the angledsurfaces 70165 a and 70165 b to continue to maintain contact against thebackside of the clip 70140 as the clip 70140 expands. Once in theexpanded configuration, the clip 70140 is advanced into the receivingchamber 70122 by the firing member 70165. The protrusions 70126 a and70126 b include angled portions which allow the clip 70140 to slide overthe protrusions 70126 a and 70126 b when the clip 70140 is advanced bythe firing member 70165. After the clip 70140 has been advanced into thereceiving chamber 70122, the firing member 70165 is retracted, and thecrimping drive 70180 is actuated to transition the first jaw 70123 a andthe second jaw 70123 b to the closed position depicted in FIG. 309 tocrimp the clip 70140 positioned in the receiving chamber 70122. Afterthe clip 70140 is crimped, another clip 70140 can be advanced onto theprotrusions 70126 a and 70126 b by the firing member 70165. When thefirst jaw 70123 a and the second jaw 70123 b are moved from the closedposition to the open position by the crimping drive 70180, the clip70140 that has been crimped in the receiving chamber 70122 will bereleased from the receiving chamber 70122 and the clip 70140 that wasadvanced onto the protrusions 70126 a and 70126 b will be expanded intoto the expanded configuration by the protrusions 70126 a and 70126 b ofthe first and second jaws 70123 a and 70123 b. Interaction between thecrimping drive 70180 and the first and second jaws 70123 a and 70123 bis discussed in further detail below.

FIGS. 312-314 depict the clip applier 70100 as described above. Inaddition, FIGS. 312-314 further depict the interaction between thecrimping drive 70180 and the first and second jaws 70123 a and 70123 b.The crimping drive 70180 comprises a first crimping drive pin 70180 aand a second crimping drive pin 70180 b protruding therefrom. The firstjaw 70123 a comprises a first jaw cam 70124 a extending therefrom andthe second jaw 70123 b comprises a second jaw cam 70124 b extendingtherefrom. In use, the crimping drive 70180 is movable between a fullyretracted position (FIG. 314 ), a home position (FIG. 313 ), and afully-fired position (FIG. 312 ). The fully-fired position canpreferably be 0.300″ distal to the home position. The fully retractedposition can preferably be 0.050″ proximal to the home position. Otherembodiments are envisioned with different distances between the homeposition, the fully retracted position, and the fully-fired position.The crimping drive 70180 cammingly engages outer surfaces of the firstjaw 70123 a and the second jaw 70123 b to transition the fist jaw 70123a and the second jaw 70123 b to a closed position when the crimpingdrive 70180 is moved into the fully-fired position (FIG. 312 )—similarto the interaction between the crimping drive 180 and the first andsecond jaws 123 a and 123 b described above. In the home position (FIG.313 ), the first and second crimping drive pins 70180 a and 70180 bengage the first jaw cam 70124 a and the second jaw cam 70124 b,respectively, such that the first jaw 70123 a and the second jaw 70123 bare moved toward the open position to release a crimped clip 70140 fromthe first and second jaws 70123 a and 70123 b. When the crimping drive70180 is in the home position, another clip 70140 can be advanced ontothe protrusions 70126 a and 70126 b as discussed above. Further, as thecrimping drive 70180 is moved from the home position (FIG. 313 ) to thefully retracted position (FIG. 314 ) the first crimping drive pin 70180a and the second crimping drive pin 70180 b transition the first jaw70123 a and the second jaw 70123 b towards the open position, and thus,the clip 70140 positioned around the protrusions 70126 a and 70126 b isexpanded into the expanded configuration, as discussed above.Alternative embodiments are envisioned in which a crimped clip 70140 isreleased from the first and second jaws 70123 a and 70123 b and, at thesame time, another clip 70140 positioned on the protrusions 70126 a and70126 b is least partially expanded when the crimping drive is movedfrom the closed position to the home position.

FIGS. 315 and 316 depict a clip applier 70150 in accordance with atleast one embodiment. The clip applier 70150 comprises a frame 70155, afiring member 70160, a first jaw 70170 a, and a second jaw 70170 b. Thefirst jaw 70170 a and the second jaw 70170 b are pivotally coupled tothe frame 70155 such that the first jaw 70170 a and the second jaw 70170b are movable relative to each other. The clip applier 70150 isconfigured to receive various types of clip cartridges, such as clipcartridge 70130 depicted in FIG. 315 , for example. The clip cartridge70130 comprises a cartridge body 70132 including a first cartridge jaw70132 a and a second cartridge jaw 70132 b that oppose each other. Whenthe clip cartridge 70130 is attached to the frame 70155 of the clipapplier 70150, the first cartridge jaw 70132 a biases the first jaw70170 a towards the second jaw 70170 b, and the second cartridge jaw70132 b biases the second jaw 70170 b towards the first jaw 70170 a.Thus, when the clip cartridge 70130 is attached to the clip applier70150, the first and second jaws 70170 a and 70170 b are approximated toform a receiving chamber 70175. The clip cartridge 70130 furthercomprises a plurality of clips 70136 removably stored in a clip housing70134. The clip cartridge 70130 further includes biasing members, suchas springs 70138 for example, configured to bias the clips 70136 out ofthe clip housing 70134 into the receiving chamber 70175. Once in thereceiving chamber 70175, a clip 70136 can be advanced by the firingmember 70160 into a crimping chamber in the distal end of the first andsecond jaws 70170 a and 70170 b. A clip 70136 positioned in the crimpingchamber can then be crimped when the first jaw 70170 a and the secondjaw 70170 b are moved towards each other.

FIG. 316 depicts a different clip cartridge 70130′ positioned in theclip applier 70150. The clip cartridge 70130′ is similar to clipcartridge 70130 discussed above, except for the differences discussedbelow. The clip cartridge 70130′ is configured to store clips 70136′which are smaller than clips 70136. Other embodiments are envisionedwhere the clip cartridge 70130′ is configured to store clips that arelarger than clips 70136. In any event, clip cartridge 70136′ comprises,one, a clip housing 70134′ which stores the clips 70136′ and, two,biasing members, such as springs 70138′ for example, which bias thestored clips 70136′ into a receiving chamber 70175′. Further, the clipcartridge 70130′ comprises a cartridge body 70132′, a first cartridgejaw 70132 a′, and a second cartridge jaw 70132 b′ opposing the firstcartridge jaw 70132 a′. The first cartridge jaw 70132 a′ and the secondcartridge jaw 70132 b′ extend further inward toward each other ascompared to the first cartridge jaw 70132 a and the second cartridge jaw70132 b of the clip cartridge 70130. Stated another way, the gap betweenthe first cartridge jaw 70132 a′ and the second cartridge jaw 70132 b′is smaller than the gap between the first cartridge jaw 70132 a and thesecond cartridge jaw 70132 b. When the clip cartridge 70130′ is attachedto the clip applier 70150, the receiving chamber 70175′ defined betweenthe first jaw 70170 a and the second jaw 70170 b will be smaller thanthe receiving chamber 70175. By changing the distance between the firstcartridge jaw and the second cartridge jaw of the clip cartridges 70130and 70130′, various sizes of receiving chambers can be created. The clipcartridges 70130 and 70130′ can therefore be modified to approximate thefirst jaw 70170 a and the second jaw 70170 b of the clip applier 70150to receive any suitable clip size.

FIG. 317 depicts a clip applier 70200 in accordance with at least oneembodiment. The clip applier comprises a shaft 70210 extending from ahousing, an end effector 70220 extending from the shaft 70210, a feedermember 70230 configured to move through the clip applier 70200 inresponse to rotary motions generated in the housing, and a clip magazine70240. The end effector comprises a pair of jaws 70225 configured tomove relative to each other between open and closed positions. The clipmagazine 70240 is not removable from the clip applier 70200; however,other embodiments are envisioned where the clip magazine 70240 isremovable and/or replaceable. The clip magazine 70240 comprises a firstlayer 70246 of clips 70244 and a second layer 70248 of clips 70244stored within the clip magazine 70240. The first layer 70246 of clips70244 are in a feeding position from which they can be ejected from theclip magazine 70240. The second layer 70248 of clips 70244 are storedabove the first layer 70246 of clips 70244 in a storage position fromwhich they cannot be ejected from the clip magazine 70240. Each of thefirst layer 70246 and second layer 70248 comprises three clips 70244,however, other embodiments are envisioned with more or less than threeclips. The first and second layers 70246 and 70248 are separated by adivider member, such as a divider plate 70249. The clip magazine 70240further comprises a top plate 70243 and biasing members 70242. The topplate 70243 rests on top of the second layer 70248 of clips 70244. Thebiasing members 70242 bias the top plate 70243 toward the top of thesecond layer 70248 of clips 70244 and, thus, bias the second layer 70248of clips 70244 toward the divider plate 70249. The divider plate 70249rests on top of the first layer 70246 of clips 70244 and a distalprotrusion 70232 of the feeder member 70230. The distal protrusion 70232extends above the feeder member 70230. Operation of the clip applier70200 is discussed in further detail below.

In use, the feeder member 70230 is translated distally to push the firstlayer 70246 of clips 70244 toward the end effector 70220 and out of theclip magazine 70240. As the first layer 70246 of clips 70244 is beingadvanced from the clip magazine 70240, the divider plate 70249 issupported by the distal protrusion 70232 of the feeder member 70230 andany of the clips 70244 which haven't been fully ejected from the clipmagazine 70240. Once the feeder member 70230 has advance all of theclips 70244 in the first layer 70246 out of the clip magazine 70240, thedivider plate 70249 is biased by the biasing members 70242 into a recess70233 in the feeder member 70230. The recess 70233 is defined betweenthe distal protrusion 70232 of the feeder member 70230 and a proximalprotrusion 70234 of the feeder member 70230 extending upward from theproximal end of the feeder member 70230. Once the divider plate 70249 isseated in the recess 70233, the feeder member 70230 and divider plate70249 can be retracted together proximally out of the clip magazine70240. After the feeder member 70230 and divider plate 70249 arecompletely retracted out of the clip magazine 70240, the second layer70248 of clips 70244 is biased by the biasing members 70242 into thefeeding position (i.e., where the first layer 70246 of clips 70244 usedto be). The feeder member 70230 and divider plate 70249 can be advancedtogether toward the end effector to eject the second layer 70248 ofclips 70244 from the clip magazine 70240. The reader will appreciatethat all of the clips 70244 in the first layer 70246 and/or second layer70248 are not ejected at the same time, rather, they are ejected one ata time to allow each clip 70244 to be sequentially crimped by the pairof jaws 70255 of the end effector 70220. The above being said, otherembodiments are envisioned in which more than one clip 70244 can beejected at a time.

FIG. 318 depicts a clip applier 70250 in accordance with at least oneembodiment. The clip applier 70250 comprises an elongate shaft 70260extending from a housing, a clip cartridge 70270 extending from theelongate shaft 70260, and an end effector 70280 extending from the clipcartridge 70270. The elongate shaft 70260 and the clip cartridge 70270define a shaft axis SA. The elongate shaft 70260 comprises a firstinwardly extending detent 70264 a and a second inwardly extending detent70264 b opposing the first inwardly extending detent 70264 a. The firstand second inwardly extending detents 70264 a and 70264 b extendinwardly toward the shaft axis SA and can flex outwardly away from theshaft axis SA when a force is applied thereto. The elongate shaft 70260further comprises a top notch 70262 a and a bottom notch 70262 bopposing the top notch 70262 a. The top notch 70262 a and the bottomnotch 70262 b are located in the distal end of the elongate shaft 70260.The clip cartridge 70270 is releasably attachable to the distal end ofthe elongate shaft 70260 as discussed in further detail below.

The clip cartridge 70270 comprises a top protrusion 70272 a and a bottomprotrusion 70272 b opposite the top protrusion 70272 a. The topprotrusion 70272 a and the bottom protrusion 70272 b extend from theclip cartridge 70270 away from the shaft axis SA. The clip cartridge70270 further comprises a first slot and a second slot 70274 b in theproximal end of the clip cartridge 70270. The first slot and the secondslot 70274 b oppose one another. The clip cartridge 70270 is configuredto slide into the inner diameter of the elongate shaft 70260 such thatthe top protrusion 70272 a slides into the top notch 70262 a, the bottomprotrusion 70272 b slides into the bottom notch 70262 b, the firstinwardly extending detent 70264 a engages the first slot of the clipcartridge 70270, and the second inwardly extending detent 70264 bengages the second slot 70274 b of the clip cartridge 70270 to attachthe clip cartridge 70220 to the elongate shaft 70260. After the clipcartridge 70270 is attached to the elongate shaft 70260, the elongateshaft 70260 and clip cartridge 70270 are fixedly coupled such that theycan rotate together about the shaft axis SA. Further, the clip cartridge70270 can be detached from the elongate shaft 70260 by a clinician whenthe clinician applies a distal force to the clip cartridge 70270 todisengage the first and second inwardly extending detents 70264 a and70264 b of the elongate shaft 70260 from the first slot and the secondslot 70274 b of the clip cartridge 70270.

Referring primarily to FIGS. 318 and 319 , the end effector 70280comprises a first jaw 70280 a and a second jaw 70280 b configured tomove relative to each other between an open position (FIG. 318 ) and aclosed position (FIG. 319 ). To this end, the first jaw 70280 a and thesecond jaw 70280 b comprise openings at the proximal end thereof whichare configured to receive a pin 70290. The pin 70290 is rotatablycaptured within an opening 70276 in the clip cartridge 70270. The pin70290 defines a pin axis PA which is orthogonal to the shaft axis SA.The first jaw 70280 a and the second jaw 70280 b are rotatable relativeto each other about the pin axis PA. When the first jaw 70280 a and thesecond jaw 70280 b are in the open position (FIG. 318 ) a clip can bepositioned between the first jaw 70280 a and the second jaw 70280 b. Asthe first jaw 70280 a and the second jaw 70280 b are r towards theclosed position (FIG. 319 ) the clip is crimped between the first jaw70280 a and the second jaw 70280 b. The first jaw 70280 a and the secondjaw 70280 b are moved from the open position to the closed position by aclosure tube which cammingly engages the outer surfaces of the first jaw70280 a and the second jaw 70280 b as the closure tube moves distally.When the closure tube is retracted, the first jaw 70280 a and the secondjaw 70280 b are returned to the open position by a biasing member, orspring, which biases the first jaw 70280 a and the second jaw 70280 binto the open position. Other embodiments are envisioned where the firstjaw 70280 a and the second jaw 70280 b are movable from the closedposition to the open position by jaw cams on the first jaw 70280 a andthe second jaw 70280 b interacting with the closure tube, similar to jawcams 70124 a and 70124 b depicted in FIGS. 312-314 , for example.

FIG. 320 depicts a clip applier 70300 in accordance with at least oneembodiment. The clip applier 70300 comprises a shaft 70310, an endeffector 70320 extending from the shaft 70310, a firing drive, and aclip magazine 70306. The clip magazine 70306 is built into the shaft70310 of the clip applier 70300 as depicted in FIG. 320 . However, otherembodiments are envisioned where the clip magazine 70306 is releasablyattachable to the clip applier 70300. The shaft 70310 comprises openings70308 on either side of the shaft 70310 which allow a user of the clipapplier 70300 to access the clip magazine 70306. Other embodiments areenvisioned with only one opening in the shaft 70310 of the clip applier.The clip applier 70300 further comprises an outer tube 70302 that isslidable along the shaft 70310 of the clip applier 70300. The outer tube70302 is configured to slide along the shaft 70310 to cover the openings70308 in the shaft 70310. The clip magazine 70306 is configured to storea plurality of clips, such as clips 70304 therein. The clips 70304 areinsertable into the clip magazine 70306 through the openings 70308 whenthe outer tube 70302 is not obstructing the openings 70308, as depictedin FIG. 320 . Once positioned in the clip magazine 70306, the clips70304 can be advanced out of the clip magazine 70306 into the endeffector 70320 by the firing member. In at least one embodiment, theclips 70304 can be sequentially advanced out of the clip magazine 70306into the end effector 70320. When the outer tube 70302 is covering theopenings 70308, access to the clip magazine 70306 is prevented, and, ifclips 70304 have already been inserted into the clip magazine 70306, theouter tube 70302 prevents the clips 70304 from exiting the clip magazine70306 through the openings 70308. Once all of the clips 70304 inside theclip magazine 70306 have been advanced into the end effector 70320, theouter tube 70302 can be retracted to allow a new set of clips to beinserted into the clip magazine 70306. Further to the above, the outertube 70302 can be operably engaged with the firing member of the clipapplier 70300, such that, when the outer tube 70302 is retracted asdepicted in FIG. 320 , or at least partially retracted, the firingmember cannot be actuated.

FIG. 322 depicts a clip applier 70300′. Clip applier 70300′ is similarto clip applier 70300 in many respects. The clip applier 70300′comprises an elongate shaft 70315 extending from a housing, anarticulation joint 70314 extending from the elongate shaft 70315, ashaft assembly 70310′ extending from the articulation joint 70314, anend effector 70320 extending from the shaft assembly 70310′, and anouter tube 70302′ positioned around the shaft assembly 70310′. Thearticulation joint 70314 connects the elongate shaft 70315 to the shaftassembly 70310′ so that the shaft assembly 70310′ can be articulatedrelative to the elongate shaft 70315. The shaft assembly 70310′comprises a proximal shaft portion 70311 extending from the articulationjoint 70314, a distal shaft portion 70312 extending from the proximalshaft portion 70311, and a hinge 70307. The distal shaft portion 70312further comprises a clip magazine 70306′. Other embodiments areenvisioned where the proximal shaft portion 70311 comprises the clipmagazine 70306′. The hinge 70307 allows the distal shaft portion 70312to rotate away from the proximal shaft portion 70311. The outer tube70302′ is configured to slide along the shaft assembly 70310′ between alocked position and an unlocked position when the proximal shaft portion70311 and distal shaft portion 70312 are aligned. More specifically,when the proximal shaft portion 70311 and distal shaft portion 70312 arealigned and the outer tube 70302′ is in the locked position, the distalshaft portion 70312 is prevented from rotating away from the proximalshaft portion 70311 about the hinge 70307. When the outer tube 70302′ isin the unlocked position, the distal shaft portion 70312 is capable ofrotating away from the proximal shaft portion 70311 about the hinge70307. Further to the above, when the distal shaft portion 70312 isrotated away from the proximal shaft portion 70311, an opening 70308′ inthe clip magazine 70306′ is exposed. The opening 70308′ allows clips70304′ to be inserted into the clip magazine 70306′.

Further to the above, a clip reloader 70350 can be utilized to insertthe clips 70304′ into the clip applier 70300′ as depicted in FIG. 322 .The clip reloader comprises a housing 70352, a trigger 70354 movablerelative to the housing 70352, a feeder bar operably engaged with thetrigger 70354, an elongate shaft 70356 extending from the housing 70352,and a docking station 70360 extending from the elongate shaft 70356. Aplurality of clips 70304′ are removably stored in the elongate shaft70356. In one embodiment, the elongate shaft 70356 stores 20 clipswithin a six inch span of the elongate shaft 70356. Other embodimentsare envisioned with different numbers of clips and spans, for example.The clips 70304′ are advanced from the elongate shaft 70356 into thedocking station 70360 by the feeder bar when the trigger 70354 is movedtowards the housing 70352. The docking station 70360 comprises a cavity70358 configured to dock with the shaft assembly 70310′ of the clipapplier 70300′ when the distal shaft portion 70312 is rotated away fromthe proximal shaft portion 70311. When the docking station 70360 isdocked with the shaft assembly 70310′ of the clip applier 70300′, theclips 70304′ can be advanced form the elongate shaft 70356 into the clipmagazine 70306′ of the clip applier.

FIGS. 323-325 depict a different clip reloader 70400. The clip reloader70400 is similar to the clip reloader 70350 in many respects. The clipreloader 70400 comprises a housing 70410, a plurality of clips 70404stored inside the housing 70410, and a plunger 70402. The plunger 70402extends into and is movable relative to the housing 70410. The clips70404 are stacked vertically in the embodiment illustrated in FIGS. 323and 324 ; however, other embodiments are envisioned where the clips arestacked horizontally. A feeder block 70406 extends from the plunger70402 and is slidably engaged with the inside of the housing 70410. Thefeeder block 70406 comprises angled portions that support the backsideof the top-most clip in the clip stack as depicted in FIG. 323 . Thehousing 70410 comprises a boss 70408 extending from the bottom of thehousing 70410, and a flexible ramp 70409 extending from the bottom ofthe boss 70408. The housing 70410 further comprises a cutout region70411. Docking the clip reloader 70400 with a clip applier is discussedin further detail below.

In various circumstances, the clip reloader 70400 is configured toinsert the clips 70404 into a clip applier, such as clip applier 70450,for example. The clip applier 70450 comprises a shaft 70460, an endeffector 70480 extending distally from the shaft 70460, and anarticulation joint 70470 extending proximally from the shaft 70460. Toalign the clip reloader 70400 with the clip applier 70450, the boss70408 docks with an opening 70464 in the shaft 70460 of the clip applier70450, the cutout region 70411 mates with the exterior of the shaft70460, and the flexible ramp 70409 extends into a clip slot 70462 of theclip applier 70450 as depicted in FIG. 325 . The opening 70464 leads tothe clip slot 70462 which comprises an angled portion that receives theboss 70408 and flexible ramp 70409 of the clip reloader 70400. The clipslot 70462 further comprises a flat portion that facilitates theadvancement of the clips 70404 into the end effector 70480 of the clipapplier 70450. The operation of the clip reloader 70400 in conjunctionwith the clip applier 70450 is discussed in further detail below.

In use, after the clip reloader 70400 is docked with the clip applier70450, the plunger 70402 is moved towards the clip applier 70450 toadvance the clips 70404 from the housing 70410 into the angled portionof the clip slot 70462. The ramp 70409 supports and guides the clips70404 from the angled portion of the clip slot 70462 into the flatportion of the clip slot 70462. As illustrated in FIG. 325 , the housing70410 of the clip reloader 70400 is positioned at an angle relative tothe longitudinal axis of the clip applier 70450 when the clip reloader70400 is docked with the clip applier 70450. Other embodiments areenvisioned where the housing 70410 is orthogonal, or at leastsubstantially orthogonal, to the clip applier 70450 when docked.Referring primarily to FIG. 325 , the clip applier 70450 furthercomprises a flexible firing member 70465 positioned within a firing slot70466 located proximal to the clip slot 70462. After the clip reloader70400 is un-docked with the clip applier 70450, the flexible firingmember 70465 can move from the firing slot 70466 into the clip slot70462 to advance the clips 70404 into the end effector 70480. Once atleast one, or all, of the clips 70404 have been advanced into the endeffector 70480, the flexible firing member 70465 can be retracted fromthe clip slot 70462 into the firing slot 70466 and additional clips70404 can be loaded into the clip slot 70462 by the clip reloader 70400.

FIGS. 326-328 depict a clip applier 70500. The clip applier 70500comprises an elongate shaft 70570 (see FIG. 328 ) extending from ahousing, a shaft 70510 attachable to the elongate shaft 70570, an endeffector 70520 extending from the shaft 70510, and a clip magazine70530. The attachable shaft 70510 comprises an upper pivot link 70512and a lower pivot link 70514 extending distally therefrom. The endeffector 70520 comprises a first jaw 70521 a and a second jaw 70521 bmovable relative to each other between an open position and a closedposition about a pivot pin 70511. The pivot pin 70511 is constrainedwithin openings in the upper pivot link 70512 and the lower pivot link70514 of the shaft 70510. The clip magazine 70530 is removablypositioned within the attachable shaft 70510 and comprises a pluralityof clips 70532. The clip applier 70500 further comprises a closuresystem 70540 and a firing system 70550. The closure system 70540 and thefiring system 70550 are discussed in greater detail below.

The closure system 70540 comprises a proximal closure driver 70542comprising a threaded portion 70543, a distal closure driver 70566comprising a closure nut 70544, an upper closure hinge 70545 a, and alower closure hinge 70545 b. The proximal closure drive 70542 isconfigured to rotate in response to rotary motions generated inside thehousing of the clip applier. The closure drive 70542 transmitsrotational motion to the threaded portion 70543 which is threadablyreceived in the closure nut 70544. The closure drive 70542 can comprisea flexible portion to facilitate the transfer of rotational motion tothe closure nut 70544. The closure nut 70544 is rotatably constrainedwithin the shaft 70510 such that rotation of the threaded portion 70543in a first direction will result in translation of the nut 70544distally, and rotation of the threaded portion 70543 in a seconddirection—opposite the first direction—will result in translation of thenut 70544 proximally. The distal closure driver 70566 extends from theclosure nut 70544 and attaches to the upper closure hinge 70545 a andthe lower closure hinge 70545 b via a closure pin 70547. The closure pin70547 allows the upper and lower closure hinges 70545 a and 70545 b totranslate distally and proximally with the distal closure driver 70566while still being rotatable about the closure pin 70547. Further to theabove, the upper closure hinge 70545 a is rotatably engaged with aproximal portion 70523 a of the first jaw 70521 a, and the lower closurehinge 70545 b is rotatably engaged with a proximal portion 70523 b ofthe second jaw 70521 b. As illustrated in FIG. 326 , the first jaw 70521a and the second jaw 70521 b cross over each other about the pivot pin70511 in a scissor like formation. Such an arrangement allows the firstjaw 70521 a and the second jaw 70521 b to move toward the open positionwhen the upper and lower closure hinges 70545 a and 70545 b aretranslated distally by the closure system 70540, and allows the firstjaw 70521 a and the second jaw 70521 b to move toward the closedposition when the upper and lower closure hinges 70545 a and 70545 b aretranslated proximally by the closure system 70540.

The clip applier 70500 further comprises a firing system 70550comprising a firing member 70560. The firing member 70560 istranslatable through the end effector between an unfired position and afired position in response to the rotary motions that drive the closuresystem 70540. Other embodiments are envisioned where the closure system70540 and the firing system 70550 are operated by two separate motorswithin the housing of the clip applier, for instance. The firing member70560 is configured to advance a clip 70532 from the clip magazine 70530into the first and second jaws 70521 a and 70521 b of the clip applier70500. As illustrated in FIG. 327 , the clip magazine 70530 is at leastpartially supported by the closure system 70540. More specifically, abiasing member, such as leaf spring 70546, for example, biases the clips70532 toward the firing member 70560 and holds the clip magazine 70530in position. Other embodiments are envisioned where the closure system70540 can align, and/or guide, and/or lock the clip magazine 70530 intoplace within the shaft 70510. The embodiment depicted in FIGS. 326 and327 illustrates the closure system 70540 arranged around the clipmagazine 70530 to allow a larger space inside the shaft 70510 for theclip magazine 70530 and clips 70532; however, a closure system can haveany suitable arrangement. The closure system 70540 is discussed infurther detail below.

The threaded portion 70543 and closure nut 70544 of the closure system70540 allows for a more precise actuation of the first and second jaws70521 a and 70521 b when moving between the open position and the closedposition as compared to previous clip applier arrangements that utilizea translating closure tube or cam member. Rotary encoders and/or othersensors can be used in combination with the closure system 70540 toprovide even greater accuracy in determining the position of the firstand second jaws 70521 a and 70521 b.

Turning now to FIG. 328 , the clip applier 70500 further compriseprotrusions 70513 and 70516 extending from the proximal end of the shaft70510. The protrusions 70513 and 70516 may be the same shape ordifferent shapes. The protrusions 70513 and 70516 are configured tolockingly engage slots 70572 a and 70572 b in the elongate shaft 70570of the clip applier 70500 to form a bayonet connection therebetween. Theslots 70572 a and 70572 b comprise L-shaped portions that lock theprotrusions 70513 and 70516 into place when the shaft 70510 is insertedinto and then rotated relative to the elongate shaft 70570. FIG. 328further depicts a clip 70532 located within the first jaw 70521 a andthe second jaw 70521 b. The clip 70532 and other embodiments of clipsfor use with a clip applier, such as clip applier 70500, are discussedin further detail below.

Turning now to FIGS. 329 and 330 , the clip 70532 comprises a baseportion 70534, a first leg 70534 a extending from the base portion70534, and a second leg 70534 b extending from the base portion 70534and opposing the first leg 70534 a. The base portion 70534 can comprisea flexible material, such as plastic and/or any other suitable flexiblematerial, to allow the clip 70532 to flex between multiple positionswithout breaking or becoming plastically deformed in an unsuitablemanner. For example, the clip 70532 can be moved between a magazinestorage configuration, a pre-firing configuration, and a post-firingconfiguration as depicted in FIG. 330 . The first leg 70534 a comprisesa reinforced region comprising a ridge 70535 a, and the second leg 70534b comprises a reinforced region comprising a ridge 70535 b. The ridges70535 a and 70535 b extend along at least a portion of the first leg70534 a and the second leg 70534 b, respectively. The ridges 70535 a and70535 b act as a rigid backbone to prevent, or at least substantiallyreduce, the deformation of the first leg 70534 a and the second leg70534 b during crimping. Other embodiments are envisioned where only oneof the first leg 70534 a and the second leg 70534 b comprises a ridge.The ridges 70535 a and/or 70535 b may be comprised of a rigid material,such as a fiberglass-filled and/or particle-filled plastic, for example,to prevent, or at least reduce, deflection of the first leg 70534 aand/or the second leg 70534 b when the clip 70532 is crimped. The clip70532 further comprises a locking portion, such as tooth 70536, forexample, extending from a portion of the first leg 70534 a. The tooth70536 lockingly engages the edges of an opening, or window, 70537 in thesecond leg 70534 b when the clip 70532 is crimped (see the post-firingconfiguration in FIG. 330 ). Such an arrangement allows the clip 70532to stay in a crimped state after the clip 70532 has been released fromthe jaws of a clip applier. Further, the clip 70532 includes gripfeatures, such as protrusions 70538, extending from the inside surfacesof the first and second legs 70534 a and 70534 b. The protrusions 70538engage tissue clamped between the first and second legs 70534 a and70534 b when the clip 70532 is crimped. The protrusions 70538 prevent,or at least substantially reduce, the movement of the tissue relative tothe clip 70532 after the clip 70532 is crimped around the tissue. Theprotrusions 70538 may be any number of shapes and sizes, such aspyramidal shapes, conical shapes, frustoconical shapes, for example,and/or any other suitable shape.

Turning now to FIGS. 331-334 , a different clip 70580 for use with aclip applier is depicted. The clip 70580 is similar to clip 70532 inmany respects. That said, the base 70534 of the clip 70580 comprises astress relief notch 70588 on the side of the base 70534 opposite thefirst and second legs 70534 a and 70534 b. In use, the stress reliefnotch 70588 allows the first and second legs 70534 a and 70534 b to flexinwardly and then outwardly a number of times without being plasticallydeformed in an unsuitable manner. However, in various circumstances, theclip 70580 can be configured to yield, or deform plastically, when theclip 70580 is sufficiently compressed. Such designed or controlledyielding, in various instances, can help the clip 70580 fold into thedesired shape.

FIGS. 335-344 depict a clip applier 70600. Turning now to FIG. 336 , theclip applier 70600 comprises a shaft 70610 extending from a housing, anend effector 70605 extending from the shaft 70610, and a rotatable clipmagazine 70650. The end effector 70605 comprises a first jaw and asecond jaw that are movable relative to each other between an openposition and a closed position, similar to the first jaw 70123 a and thesecond jaw 70123 b of the clip applier 70100 discussed above. Therotatable clip magazine 70650 is rotatably and slidably supported withinthe clip applier 70600. More specifically, the rotatable clip magazine70650 is rotatable about shaft axis SA and translatable along shaft axisSA. The shaft axis SA is defined by the shaft 70610. Further detailregarding how the clip magazine 70650 is supported within the clipapplier 70600 is provided below.

Referring to FIG. 335 , the rotatable clip magazine 70650 comprises abody portion 70652 including five sides, each of which comprises a clipchannel 70656 configured to removably store a clip 70654 therein. Thebody portion 70652 further comprises an opening 70653 that extendsthrough the body portion 70652. In the illustrated embodiment, the bodyportion 70652 is pentagonal in shape, for example; however, otherembodiments are envisioned in which the opening 70653 comprisesdifferent shapes to allow for more than or less than five clip channels70656 and, therefore, more than or less than five clips 70654 stored inthe rotatable clip magazine 70650. In at least one embodiment, the clips70654 comprise a clip width of 0.080″, a clip thickness of 0.03″, and aclip length of 0.310″ (for a Lig 5 Clip) or 0.315″ (for an ER320 Clip),for example; however, clips having any suitable size can be used.Moreover, it is envisioned that the clips stored in the clip magazine70650 will have the same, or at least substantially the same size;however, alternative embodiments are envisioned in which clips havingdifferent sizes may be stored in the same clip magazine. Further, in atleast one embodiment, the overall diameter of the entire rotatable clipmagazine 70650 is 0.996″, for example; however, the clip magazine 70650can have any suitable diameter—including diameters which can permit theclip magazine 70650 to be inserted through a trocar. The rotatable clipmagazine 70650 further includes a clocking portion, such as teeth 70658,for example, extending proximally from the clip magazine 70650. The clipapplier 70600 comprises several drives and drivers which define themotion and/or operating sequence of the clip applier 70600, as describedin further detail below.

Referring again to FIG. 336 , the clip applier 70600 further comprises aclosure tube 70620, a feeder member 70630, and a firing member 70640.The closure tube 70620 comprises a closure drive 70625 extendingproximally from the closure tube 70620. The closure drive 70625 extendsthrough the opening 70653 in the clip magazine 70650 and is operablyengaged with an actuator inside the housing of the clip applier 70600.The clip magazine 70650 is supported on at least a portion of theclosure drive 70625. The closure tube 70620 is at least partiallysupported and aligned within a recess in the shaft 70610. The closuretube 70620 is movable between a plurality of positions, such as a fullyretracted position, a home position, and a fully advanced position (seeFIGS. 336 and 337 ). Similar to the crimping drive 70180 of the clipapplier 70100, the closure tube 70620 is configured to move the firstjaw and the second jaw of the end effector 70605 toward and away fromeach other. When the closure tube 70620 moves distally, the closure tube70620 cammingly engages the first and second jaws to move the first andsecond jaws to the closed position and, when the closure tube 70620moves proximally, the closure tube 70620 engages jaw cams on each of thefirst and second jaws to move the first and second jaws to the openposition. That said, any suitable jaw opening and closing arrangementcould be used.

The feeder member 70630 is aligned with one of the clip channels 70656of the rotatable clip cartridge 70650, and is configured to advance aclip 70654 out of the clip channel 70656 that is aligned with the feedermember 70630 toward the end effector 70605. The feeder member 70630 istranslatable linearly through the clip applier 70600 by a feeder gear70638 and a feeder drive 70635 which are operably engaged with a rackportion of the feeder member 70630. The feeder drive 70635 comprises apinion gear 70637 at the distal end thereof which is operably engagedwith the feeder gear 70638 such that, as the feeder drive 70635 isrotated, the feeder member 70630 is translated linearly through the clipapplier 70600. The feeder drive 70635 is operably engaged with a firstmotor inside the housing of the clip applier 70600. The first motortransmits rotational motion to the feeder drive 70635. Similar to theoperation of the feeder member 70630, the firing member 70640 istranslatable linearly through the clip applier by a firing gear 70648and a firing drive 70645 which are operably engaged with a rack portionof the firing member 70640. The firing drive 70645 comprises a piniongear 70647 on the distal end thereof which is engaged with the firinggear 70648 such that, as the firing drive 70645 is rotated, the firingmember 70640 is translated linearly through the clip applier 70600.Further, the firing drive 70645 is operably engaged with a second motorinside the housing of the clip applier 70600. The second motor transmitsrotational motion to the firing drive 70645. Other embodiments areenvisioned where the feeder drive 70635 and the firing drive 70645 arerotatable by the same motor utilizing a transmission. Further, otherembodiments are envisioned, and are described further below, where thefeeder member 70630 and the firing member 70640 translate togetherthrough the clip applier 70600. Operation of the feeder member 70630 andfiring member 70640 are also described in greater detail below.

Referring primarily to FIG. 336 , the firing member 70640 comprises adistal portion 70640 a extending therefrom that is configured to advancea clip 70654 into the end effector. The shaft 70610 further includes aground portion 70612 mounted to the shaft 70610 and aligned with theclip magazine 70650. The ground portion 70612 is mounted to the shaft70610 such that the ground portion 70612 is not movable, translatable,and/or rotatable relative to the shaft 70610. The ground portion 70612includes a clocking portion, such as teeth 70614, for example, extendingdistally therefrom as illustrated in FIG. 338 . The teeth 70614 of theground portion 70612 are aligned, or at least substantially aligned,with the teeth 70658 of the rotatable clip magazine 70650. Further, theground portion 70612 supports a biasing member, such as spring 70616,for example, thereon. The spring 70616 biases the clip magazine 70650distally toward the closure tube 70620 and the end effector 70605, asillustrated in FIG. 337 . Other embodiments are envisioned where thespring comprises a leaf spring and the clip applier 70600 furthercomprises a track and the leaf spring can be configured to both indexthe clip magazine 70650 and prevent the clip magazine 70650 from counterrotation. In any event, the rotation of the clip magazine 70650 aboutthe shaft axis SA and translation of the clip magazine 70650 along shaftaxis SA is described in further detail below.

Referring primarily to FIG. 335 , the closure tube 70620 includesclocking channels 70622 located radially around the closure drive 70625.The closure drive 70625 rotatably and slidably supports the rotatableclip magazine 70650 thereon as discussed above. The clocking channels70622 are engaged with protrusions within the opening 70653 of the clipmagazine 70650 to rotatingly lock the clip magazine 70650 into placerelative to the closure tube 70620 when the closure tube is in the homeposition or the fully advanced position. When the closure tube 70620 ismoved to the fully retracted position, as illustrated in FIG. 336 , thespring 70616 moves/biases the clip magazine 70650 toward the closuretube 70620 resulting in the clocking channels 70622 becoming disengagedfrom the protrusions within the opening 70653 of the clip magazine70650. As such, the clip magazine 70650 can rotate freely about shaftaxis SA. Further, when the closure tube 70620 is moved to the fullyretracted position, the teeth 70658 of the clip magazine 70650 engagethe teeth 70614 of the ground portion 70612 to rotate (i.e., cycle) theclip magazine 70650. More specifically, the teeth 70658 and the teeth70614 are structured to rotate the clip magazine 70650 about the shaftaxis SA a predefined amount of degrees based on the spacing and anglesof the teeth 70658 relative to the teeth 70614. The reader willappreciate that the spacing and angles of the teeth 70658 relative tothe teeth 70614 can be designed to generate a suitable degree ofrotation for the clip magazine 70650 about shaft axis SA. In theembodiment depicted in FIGS. 335-337 , the teeth 70658 and the teeth70614 are spaced and aligned such that, when they are engaged, the clipmagazine 70650 rotates 72 degrees to align an adjacent clip 70654 withthe feeder member 70630. After the clip magazine 70650 is cycled, theclosure tube 70620 can be moved distally from the fully retractedposition to the home position (FIG. 337 ) resulting in the clockingchannels 70622 engaging the protrusions in the opening 70653 of the clipmagazine 70650 to lock the rotation of the clip magazine 70650 asdiscussed above. Usage of the clip applier 70600 to advance, form, andfire a clip 70654 is describe in further detail below.

As mentioned above, the feeder member 70630 and firing member 70640 canbe translatable together. For simplicity, FIGS. 339-344 illustrate thefunctions of clip applier 70600 where the feeder member 70630 and firingmember 70640 move together to feed and fire a clip 70654 from therotatable clip magazine 70650. Turning now to FIGS. 339 and 340 , a clip70654 is advanced from the rotatable clip magazine 70650 into engagementwith a biasing member, such as a leaf spring 70624, for example, of theclosure tube 70620 by the feeder member 70630. The leaf spring 70624biases and guides the clip 70654 onto the top of the firing member70640, as illustrated in FIG. 340 . When the firing member 70640 andfeeder member 70630 are retracted, the clip 70654 is moved furtherdownward by the leaf spring 70624 and seated around pre-form features,such as protrusions 70608, for example, depicted in FIG. 341 .Protrusions 70608 can be similar to protrusions 70126 a and 70126 bdescribed above (See FIGS. 309 and 310 ). One protrusion 70608 islocated on one jaw of the end effector 70605, and another protrusion70608 is located on another jaw of the end effector 70605.

When the closure tube 70620 is in the fully retracted position,referring to FIG. 342 , the jaws of the clip applier 70600 are in theopen position and the protrusions 70608 expand the clip 70654 from astorage configuration into a firing configuration—similar to theexpansion of clip 70140 described above in connection with FIGS. 309 and310 . When the closure tube 70620 is moved to the fully retractedposition, as described above, the rotatable clip magazine 70650 isrotated (i.e., cycled) about the shaft axis SA to position another clip70654 into alignment with the feeder member 70630. Turning to FIG. 343 ,the firing member 70640 can be moved toward the end effector 70605 toadvance the clip 70654 over the protrusions 70608 and into the endeffector 70605. As discussed above in connection with protrusions 70126a and 70126 b, the protrusions 70608 can comprise angled portions thatallow the clip 70654 to slide over the protrusions 70608 when advanceddistally by the firing member 70640. Once the clip 70654 is positionedin the end effector 70605, the closure tube 70620 can be moved to thefully advanced position (FIG. 344 ) to move the jaws from the openposition to the closed position to crimp the clip 70654 positionedbetween the jaws.

Because the feeder member 70630 and the firing member 70640 translatetogether, further to the above, the feeder member 70630 advances anotherclip 70654 (i.e., the clip that was rotated into position when theclosure tube 70620 was fully retracted) from the clip cartridge 70650down onto the firing member 70654 with the aid of the leaf spring 70624,as discussed above, when the firing member 70640 advances a clip 70654into the end effector 70605. Again, the firing member 70640 and thefeeder member 70630 can be retracted to allow the new clip 70654 to bebiased downward by the leaf spring 70624 and seated around theprotrusions 70608. The new clip 70654 can then be expanded to the firingconfiguration as clip magazine 70650 is cycled, and then the new clip70654 can be advanced into the end effector 70605 for crimping asdiscussed above. The process discussed above can be repeated until theclip magazine 70650 has been spent. The reader will appreciate that theclosure tube 70620 can be moved between the home position (FIGS. 340 and341 ) and the fully advanced position (FIG. 344 ) to crimp and release aclip 70654 within the end effector 70605 without cycling the clipmagazine 70650. This allows the jaws of the end effector 70605 to movebetween the open and closed positions without cycling the clip magazine70650 and/or ejecting another clip from the clip magazine 70650.

FIG. 345 depicts a clip applier 70700 in accordance with at least oneembodiment. The clip applier 70700 comprises a shaft 70710 extendingfrom a housing, an end effector 70705 extending from the shaft 70710,and a clip cartridge 70720 that is releasably attachable to the clipapplier 70700. The end effector 70705 comprises a first jaw and a secondjaw movable relative to each other, similar to the first and second jaws70123 a and 70123 b discussed above. The clip applier 70700 furthercomprises a firing system 70730 that comprises a rotatable drive 70732which is operably responsive to a motor inside the housing of the clipapplier 70700. The rotatable drive 70732 comprises a threaded portion.The firing system 70730 further includes a firing member 70736 and afiring nut 70734. The firing nut 70734 is threadably received on thethreaded portion of the rotatable drive 70732. The firing nut 70734 isrotatably constrained within the clip applier 70700 such that therotation of the rotatable drive 70732 translates the firing nut 70734through the clip applier 70700. The firing member 70736 is engaged withthe firing nut 70734 and translates into the first and second jaws ofthe end effector 70705 in response to translation of the firing nut70734 by the rotatable drive 70732. Attachment of the clip cartridge70720 to the clip applier 70700 is described in greater detail below.

The clip applier 70700 further comprises a docking region, or recess70714, in the distal end of the clip applier 70700, as illustrated inFIG. 345 . The clip cartridge 70720 comprises a body portion 70722 thatis slidably receivable in the recess 70714 of the clip applier 70700. Alocking feature 70728 extends proximally from the clip cartridge 70720.The locking feature 70728 includes an angled surface 70728 a at theproximal end thereof and a detent 70728 b extending downwardly, althoughthe locking feature 70728 can include any suitable arrangement. Thelocking feature 70728 engages a protrusion 70712 of the shaft 70710 whenthe clip cartridge 70720 is docked within the recess 70714. Morespecifically, the angled surface 70728 a slides over the protrusion70712 and the downwardly extending detent 70728 b locks into placeproximal to the protrusion 70712, thus locking the clip cartridge 70720to the clip applier 70700. In such instances, the locking feature 70728deflects as the angled surface 70728 a slides over the protrusion 70712and then resiliently returns to, or at least toward, its undeflectedconfiguration, when the detent 70728 b locks into place. A sufficientdistal pulling motion can cause the locking feature 70728 to deflect andrelease the clip cartridge 70720 from the clip applier 70700. Operationof the clip applier 70700 is described in further detail below.

The clip cartridge 70720 further comprises a ramp portion 70721, aplurality of clips 70724 positioned in a stack, and biasing members,such as springs 70726, for example. The clips 70724 are biased towardthe ramp portion 70721 by the springs 70726. In fact, the top clip 70724in the stack of clips is biased into the ramp portion 70712 by thesprings 70726. When the clip cartridge 70720 is docked with the clipapplier 70700, as discussed above, the ramp portion 70721 aligns with afeeder drive 70740 of the clip applier 70700. The feeder drive 70740 isoperably responsive to an actuator within the housing of the clipapplier 70700. The feeder drive 70740 is configured to reciprocatinglyactuate into the ramp portion 70721. To accommodate an angled portionwithin the ramp portion 70721 the feeder drive 70740 can be flexible.The feeder drive 70740 feeds the top clip 70724 in the stack of clipsthrough the ramp portion 70721 and into the end effector 70720. Once inthe end effector 70705, the clip 70724 can be advanced further distallyinto the first and second jaws of the end effector 70705 by translationof the firing member 70736, as discussed above. Once located in thefirst and second jaws, the clip 70724 can be crimped by a crimpingdrive. The feeder drive 70740 can be retracted, allowing another clip70724 to be biased into the ramp portion 70721. The feeder drive 70740can advance the new clip 70724 through the ramp portion 70721 and intothe first and second jaws of the end effector 70705 as discussed above.The process discussed above can be repeated until all of the clips 70724in the clip cartridge 70720 have been depleted, and/or until a suitablenumber of clips have been applied to the tissue.

FIG. 346 depicts a clip applier system 70750 in accordance with at leastone embodiment. The clip applier system 70750 comprises a shaft 70760extending from a housing, the clip applier 70250 depicted in FIG. 318positioned at least partially within the shaft 70760, and the rotatableclip magazine 70650 depicted in FIGS. 335-344 positioned within theshaft 70760. A feeder member is configured to advance the clips 70654from the rotatable clip magazine 70650—one at a time—into the first andsecond jaws 70280 a and 70280 b of the clip applier 70250. Once locatedwithin the first and second jaws 70280 a and 70280 b, the clip 70654 canbe crimped as discussed above in relation to FIGS. 318 and 319 . Oncethe clip 70654 is crimped, the rotatable clip magazine 70650 can becycled (i.e., rotated) to position another clip 70654 for advancementinto the first and second jaws 70280 a and 70280 b of the clip applier70250 by the feeder member. This process can continue until all of theclips 70654 in the rotatable clip magazine 70650 have been spent. Afterall of the clips 70654 have been spent, the rotatable clip magazine70650 can be replaced with another rotatable clip magazine 70650containing a full complement of clips 70650. Other embodiments areenvisioned where the spent rotatable clip magazine 70650 can be detachedfrom the clip applier system 70750, reloaded with clips 70650, and thenre-attached to the clip applier system 70750 for further use.

Turning now to FIGS. 348 and 349 , an articulation joint 70800 for usewith a clip applier is illustrated. The articulation joint 70800releasably couples a clip cartridge 70820 to a shaft 70810 of a clipapplier. The shaft 70810 comprises an articulation pivot, or pivot pin70814, extending from the inside of the shaft 70810. The pivot pin 70814comprises a base portion 70817, a first leg 70814 a extending from thebase portion 70817, and a second leg 70814 b extending from the baseportion 70817 and opposing the first leg 70814 a. The first and secondlegs 70814 a and 70814 b extend away from each other. The first leg70814 a comprises a first detent, or shoulder, 70816 a extendingoutwardly from the first leg 70814 a, and the second leg 70814 bcomprises a second detent, or shoulder, 70816 b extending outwardly fromthe second leg 70814 b. The clip cartridge 70820 comprises a firstopening 70822 and, also, a second opening 70824 positioned adjacent andlateral to the first opening 70822. The first opening 70822 is centeredin the clip cartridge 70820 and rotatably receives the pivot pin 70814when the clip cartridge 70820 is attached to the shaft 70810. The firstleg 70814 a and the second leg 70814 b flex towards each other when thefirst opening 70822 is slid onto the pivot pin 70814 due to angledsurfaces at the end of each of the first leg 70814 a and second leg70814 b (See FIG. 349 ). As the first leg 70814 a and second leg 70814 bflex toward each other, the pivot pin 70814 can slide through the firstopening 70822 until the first and second detents 70816 a and 70816 bclear the first opening 70822, as illustrated in FIG. 349 . Once thefirst and second detents 70816 a and 70816 b clear the first opening70822, the first and second legs 70814 a and 70814 b can expand to lockthe clip cartridge 70820 to the pivot pin 70814. More specifically, thebottom surfaces of the first and second detents 70816 a and 70816 b reston an outer surface 70826 of the clip cartridge 70822 preventing theclip cartridge 70820 from being detached from the pivot pin 70814 unlessa sufficient force is applied that exceeds a predetermined, or designed,force threshold. The reader will appreciate that, with force, a user ofthe clip applier can attach and detach the clip cartridge 70820 to theshaft 70810. Articulation of the clip cartridge about the pivot pin70814 is described in further detail below.

The clip applier depicted in FIGS. 348 and 349 further comprises arotatable output 70830 that is operably responsive to a motor locatedwithin the housing of the clip applier. The rotatable output 70830 isthreadably engaged with a threaded portion 70834 of an articulation bar70832. Rotation of the rotatably output 70830 in a first directiontranslates the articulation bar 70832 distally, and rotation of therotatable output 70830 in a second, or opposite, direction translatesthe articulation bar 70832 proximally. The articulation bar 70832comprises a downwardly extending protrusion 70836 that is slidablyreceived in a slot 70812 defined in the shaft 70810. The protrusion70836 and slot 70812 guide the articulation bar 70832 as thearticulation bar 70832 translates and limit relative lateral motionbetween the articulation bar 70832 and the shaft 70810. The articulationbar 70832 further comprises an upwardly extending protrusion 70838 whichis received in the second opening 70824 of the clip cartridge 70820 whenthe clip cartridge 70820 is attached to the shaft 70810. In use, thedistal translation of the articulation bar 70832 will rotate the clipcartridge 70820 about the pivot pin 70814 in a first direction and theproximal translation of the articulation bar 70832 will rotate the clipcartridge 70820 about the pivot pin 70814 in a second, or opposite,direction. The articulation bar 70832 can be flexible to allow thearticulation bar 70832 to flex as needed when the clip cartridge 70820is articulated about the pivot pin 70814.

FIG. 350 depicts a clip applier 70900 in accordance with at least oneembodiment. The clip applier 70900 comprises an elongate shaft 70910, anarticulation joint 70920, and a distal head 70930. The articulationjoint 70920 extends from the elongate shaft 70910 and the distal head70930 extends from the articulation joint 70920. The distal head 70930comprises a distal shaft 70932 attached to the articulation joint 70920,an end effector 70936 including a first jaw 70936 a and a second jaw70936 b, and a clip cartridge 70934. The first jaw 70936 a and secondjaw 70936 b are movable relative to each other between open and closedpositions by any suitable drive system, such as the drive systemsdisclosed herein, for example. The clip cartridge 70934 stores aplurality of clips which can be advanced into the end effector 70936 andcrimped by the first jaw 70936 a and the second jaw 70936 b. The clipcartridge 70934 is removably attachable to the distal shaft 70932 via akeying arrangement 70938. Other embodiments are envisioned where theclip cartridge 70934 is not removably attachable to the distal shaft70932. The elongate shaft 70910 defines a first roll axis RA₁ and thedistal head 70930 defines a second roll axis RA₂. The elongate shaft70910 and the distal head 70930 are articulable relative to each otherabout articulation axis AA via the articulation joint 70920. Thearrangement depicted in FIG. 350 is attachable—via the elongate shaft70910—to a plurality of clip applier handle types, such as, a standardhandle (i.e., a wand grip) and/or a pistol grip handle, for example.Depending on the type of handle that is attached to the elongate shaft70910, different actuations of, or within, the handle may performdifferent actuations of the arrangement depicted in FIG. 350 about thefirst roll axis RA₁, the second roll axis RA₂, and the articulation axisAA. These actuations are described in further detail below.

If the elongate shaft 70910 is attached to a standard handle (i.e., awand handle), referring still to FIG. 350 , the elongate shaft 70910,the articulation joint 70920, and the distal head 70930 are allrotatable about the first roll axis RA₁ by the clinician rotating thewand handle. Further, a rotary knob on the wand handle is operablyengaged with the elongate shaft 70910, through an electric motor and/orcontrol system, for example, such that manually rotating the rotary knobwill result in the distal head 70930 rotating about the second roll axisRA₂. Further, articulation of the distal head 70930 relative to theelongate shaft 70910 about articulation axis AA is driven by anarticulation driver operably engaged with a motor housed within the wandhandle, for example. If the elongate shaft 70910 is attached to a pistolgrip handle, such as the handle 700 discussed above, for example, theelongate shaft 70910, the articulation joint 70920, and the distal head70930 are all rotatable about the first roll axis RA₁ by a rotary knob,for example. Further, the distal head 70930 is rotated about the secondroll axis RA₂ by a dedicated motor within the pistol grip handle.Further still, articulation of the distal head 70930 relative to theelongate shaft 70910 about articulation axis AA is induced by anarticulation driver operably engaged with a motor housed within thepistol grip handle. The reader should appreciate that, depending on thetype of handle attached to the arrangement depicted in FIG. 350 ,rotation of the elongate shaft 70910 about the first roll axis RA₁ canbe accomplished by rotating the entire handle manually, rotation of arotary knob engaged with the elongated shaft, and/or by a dedicatedmotor inside the handle. Further, the rotation of the distal head 70930about the second roll axis RA₂ can be accomplished by rotation of arotary knob engaged within the elongate shaft 70910 or by a dedicatedmotor inside the handle.

A clip applier jaw assembly 70950, or half of the jaw assembly 70950,and a clip leg 70954 of a clip are illustrated in FIG. 351 . As can beseen in FIG. 351 , the clip applier jaw assembly 70950 comprises a firstjaw 70950 a which includes a base 70952, a first leg 70952 a extendingfrom the base 70952, and a second leg 70952 b extending from the base70952. The first leg 70952 a and second leg 70952 b oppose one anotherand define a receiving area 70953 therebetween. The clip leg 70954 isreceived in the receiving area 70953 but, notably, part of the clip leg70954 cross-section is not positioned within the receiving area 70953.Thus, only portions of the clip leg 70954 cross-section are supported bythe first jaw 70950 a. Other arrangements exist where the receiving area70953 is substantially the same depth and width as the clip leg 70954 ofthe clip such that all, or at least substantially all, of thecross-section of the clip leg 70954 is positioned within the receivingarea 70953 and supported by the first jaw 70950 a.

A clip applier jaw assembly 70960 is depicted in FIG. 352 . The clipapplier jaw assembly 70960 comprises a first jaw 70960 a which includesa base 70962, a first leg 70962 a, a second leg 70962 b, and a receivingarea 70963 which receives a first clip leg 70964 of a clip. The firstleg 70962 a of the first jaw 70960 a extends from the base portion 70962beyond the first clip leg 70964 when the first clip leg 70964 is seatedin the receiving area 70963. The second leg 70962 b of the first jaw70960 a extends from the base portion 70962 and terminates prior to theend of the first clip leg 70964 such that only a portion of the firstclip leg 70964 is supported by the second leg 70962 b of the first jaw70960 a.

The clip applier jaw assembly 70960 further comprises a second jaw 70960b positioned opposite, or opposing, the first jaw 70960 a. The secondjaw 70960 b comprises a base 70962′, a first leg 70962 a′, a second leg70962 b′, and a receiving area 70963′ which receives a second clip leg70964′ of the clip. The second jaw 70960 b opposes the first jaw 70960 asuch that the first leg 70962 a of the first jaw 70960 a is aligned withthe first leg 70962 a′ of the second jaw 70960 b, and the second leg70962 b of the first jaw 70960 a is aligned with the second leg 70962 b′of the second jaw 70960 b. The second leg 70962 b′ of the second jaw70960 b extends from the base portion 70962′ beyond the second clip leg70964′ of the clip when the second clip leg 70964′ is seated in thereceiving area 70963′. Further, the first leg 70962 a′ of the second jaw70960 b extends from the base portion 70962′ and terminates prior to theend of the second clip leg 70964′ such that only a portion of the secondclip leg 70964′ is supported by the first leg 70962 a′ of the second jaw70960 b.

When the first jaw 70962 a and the second jaw 70962 b of the clipapplier jaw assembly 70960 are in a closed configuration, as depicted inFIG. 353 , the first leg 70962 a of the first jaw 70960 a supports theentire first clip leg 70964 of the clip and, also, a portion of thesecond clip leg 70964′ of the clip. Further, the second leg 70962 b′ ofthe second jaw 70960 b supports the entire second clip leg 70964′ of theclip and, also, a portion of the first clip leg 70964 of the clip.Because the first leg 70962 a of the first jaw 70960 a and the secondleg 70962 b′ of the second jaw 70960 b are opposite one another, thecross-sections of the first clip leg 70964 and the second clip leg70964′ are supported by both the first jaw 70960 a and the second jaw70960 b—along at least a portion of the leg lengths. Such an arrangementprevents, or at least inhibits, the clip from twisting when the clip iscrimped.

Referring to FIG. 354 , the clip leg 70954 is seated within the firstclip jaw 70950 a of the clip applier jaw assembly 70950 but is notprevented from being slid longitudinally within the clip applier jawassembly 70950. In accordance with at least one embodiment, such as theclip applier jaw assembly 70960, for example, the first jaw 70960 aand/or the second jaw 70960 b comprise a clip ejection preventionfeature, such as distal stop 70966. The distal stop 70966 prevents theclip 70964 from sliding out of the distal end of the first jaw 70950 aand/or the second jaw 70950 b of the clip applier jaw assembly 70960.Other clip applier jaw shapes and guidance features configured tocontrol the position of the clip, and/or prevent the unintentionaldropping and/or ejection of the clip from the clip applier, arediscussed in greater detail below.

As discussed above, the jaws of a clip applier, or “clip jaws”, are usedto deform the clips. As the reader should appreciate, the clip jawsthemselves undergo stresses and strains and, in some instances, can beplastically deformed. Clip jaws designed to resist plastic deformationduring use may comprise clip jaws which vary in thickness, width, and/orclip path depth along the clip jaw lengths in order to improve thestiffness in a lap clip applier, for example. Further, a proximalportion of one of the clip applier jaws can comprise a protruding bar(i.e., a tongue portion) and a proximal portion of the other clipapplier jaw can comprise a recess (i.e., a groove portion) such that theprotruding bar is seated in the recess when the clip applier jaws areclosed. Such an arrangement provides for superior jaw resilience tovertical skewing and/or twisting of the clip applier jaws relative toeach other during crimping of a clip. Improved clip retention structuresare discussed in further detail below.

In at least one embodiment, the clip applier jaws may comprise a clipretention channel, or recess, to allow a clip to be advanced into theclip applier jaws via a feeder member from below. The feeder memberincludes a flexible drive plate that is retracted when the clip applierjaws are actuated (i.e., moved from an open position to a closedposition) and is extended into the distal end of the clip applier jawsto hold the clip in a distal position until the clip applier jaws areactuated. Further, the feeding member prevents any further clips frominadvertently advancing into the clip applier jaws until the feedermember is retracted to retrieve and advance the next clip. Clip applierjaws including a distal retaining feature are discussed in greaterdetail below.

In at least one embodiment, the clip applier jaws each comprise a distalretaining feature, such as a ledge, for example, that extends above aguidance trough in the clip applier jaws. The guidance trough maycomprise retention features, such as recesses, for example, on thedistal end thereof which mate with protrusions on the clip to allow theclip to remain in a distal position within the clip applier jaws withoutneeding to be held into place by a firing member and/or feeder member.The construction and manufacturing of certain clip applier jaws isdiscussed in greater detail below.

In various embodiments, the clip applier jaws are manufactured using atwo part method where at least the distal portions of the clip applierjaws are metal injection molded (MIM) within an injection mold. Incertain instances, the injection mold comprises two sides which aretranslatable toward and away from each other along a parting axis andthe interface between the two mold halves is often planar, or at leastsubstantially planar, and is often called a “parting plane”. In at leastone such instance, the parting plane is perpendicular to the axis of aclip trough of the clip applier jaws formed within the injection mold.Such an arrangement allows stiffening features, such as a rail, forexample, to be designed onto the back side of the clip applier jaws,friction or holding features within the clip trough, and/or the distalholding features discussed above, for instance. Using a MIM process mayoften require the clip applier jaws to be machined, ground, and/orpolished, for example, after being removed from the injection mold. Theclip applier jaws are then either pivotally pined together and/or weldedpivotally to the connection features of an end effector. By using MIM toproduce certain portions of the jaws, the cost to produce the jaws canbe reduced as inexpensive manufacturing methods can be utilized for theconnection features, as opposed to using MIM to produce the entire clipapplier jaws. Further, the clip applier jaws can be independentlymanufactured using MIM and then welded to a spring based interconnectionclip. Moreover, independently manufactured clip applier jaws that arethereafter assembled together allows for the clip applier jaws to have ametallic clip guidance track to be built into the lateral inside facingportion of the clip applier jaws. The independently manufactured clipapplier jaws using MIM may further comprise distal clip retentionfeatures, such as ledges, for example, which prevent the unintentionalejection of a clip from the distal end of the clip applier jaws. Suchdistal clip retention features can extend above the primary face of theclip applier jaws owing to these MIM processes.

As discussed above, and as described in greater detail below, certainclip appliers are configured to be inserted into a patient through apassage defined in a trocar. That said, the clip jaws of many clipappliers are wider than the trocar passage when they are in their openconfiguration. Described below are various systems that can beincorporated into a clip applier to facilitate the insertion of the clipapplier through the trocar passage.

Referring to FIG. 356 , a graph 71000 depicts the movements of a cammember and a feeder/firing member of a clip applier, such as the clipapplier 70100, for example. The cam member is similar to cam member70180 and the feeder shoe is similar to firing member 70165 illustratedin FIGS. 309-314 , for example. In order to configure the clip applier70100 in a trocar-insertion configuration, the cam member is moved to afully advanced position to close the jaws of the clip applier and thefeeder shoe is moved to a fully retracted position. In variousinstances, the clip applier comprises a control system including abutton which, when depressed, places the clip applier in itstrocar-insertion configuration. In at least one instance, the controlsystem operates the one or more electric motors of the clip applier toconfigure the drive systems as described above. At such point, the clipapplier is ready to be inserted into the patient through the trocar.Once inserted into the patient, the button can be pressed again and, inresponse thereto, the control system will retract the cam member to afully retracted position and open the jaws of the clip applier. Thisbutton can be pressed repeatedly to toggle the configuration of the clipapplier as needed. Such an arrangement is also useful to remove the clipapplier from the patient through the trocar. The reader shouldappreciate that the opening and closing of the jaws via the button willnot affect the other functions of the clip applier such as advancing aclip, forming a clip, and/or ejecting a clip from the clip magazine.

Once the clip applier has been inserted through the trocar and thebutton has been actuated a second time (i.e., the jaws are open),further to the above, a firing button can be pressed resulting in thefeeder shoe advancing to a fully advanced position. A clip will beadvanced with the feeder shoe as described above in relation to clipapplier 70100 (FIGS. 309-314 ), for instance. The feeder shoe can thenbe retracted to a fully retracted position and the cam member can beadvanced to the fully advanced position to form the clip around tissueof the patient, as also described above. The cam member can then beretracted to the fully retracted position to release the clip and thetissue. Once all of the clips have been applied, or at least asufficient number of clips have been applied, the button could beactuated again to close the jaws to allow the clip applier to be removedthrough the trocar. Such an arrangement enables the user of the clipapplier to close the jaws without releasing a loose clip into thepatient.

Further to the above, embodiments are envisioned where a clip appliercomprises a motor and a motor controller. The motor controller can beconfigured to control the motor via a processor and a memory. The motorcontroller can implement motor control algorithms to configure the jawsto open and close as well as advance a clip into the jaws. For example,a motor control algorithm can be implemented to allow the jaws toadvance a clip into a crimping and/or forming position, as describedabove, after the jaws have been inserted through the trocar. By notfeeding a clip into the jaws until after the clip applier has beenintroduced into the patient, the jaws can be moved into a very compactarrangement when being inserted through the trocar as discussed above.

Turning now to FIG. 357 , a graph 71100 depicts the movements of a cammember and a feeder shoe of a clip applier comprising a rotating clipmagazine (i.e., a barrel magazine), such as the clip applier 70600, forexample. The operation of the clip applier depicted in FIG. 357 issimilar to that of clip applier 70600 in many respects. For example, thecam member is similar to closure tube 70620, the feeder shoe is similarto feeder member 70630, and the barrel magazine is similar to rotatableclip magazine 70650 illustrated in FIGS. 335-344 , for example. The clipapplier is placed into the patient through a trocar with the jaws closedand a clip positioned in the jaws and another clip aligned with thefeeder shoe for deployment out of the barrel magazine. With the feedershoe in the home position (i.e., zero displacement) the cam member canbe advanced to a fully advanced position from the home position to crimpthe clip already placed within the jaws. In at least one instance, thedistance between the home position and the fully advanced position is0.3″, for example. The cam member is then retracted to a partiallyadvanced position just proximal to the fully advanced position to reducethe force applied to the clip by the jaws. The cam member is advancedagain to the fully advanced position to crimp the clip again. Byapplying a force, reducing that force, and then applying the same, oranother, force again, the elasticity within the clip can be reduced suchthat full plastic deformation can occur to properly crimp the clip ontothe patient tissue. The partially advanced position is dependent on thetype of clip being utilized with the clip applier. For example, thepartially advanced position is preferably 0.2″ distal from the homeposition for a clip with a clip opening of 0.210″ and is preferably0.23″ distal from the home position for a clip with a clip opening of0.180″, for example. Suitable thresholds can be set by the userdepending on the type of clips in the barrel magazine being utilizedwith the clip applier. Other embodiments are envisioned with differentclip sizes and position arrangements for the partially retracted andfully advanced positions.

In any event, after the clip has been properly crimped, the cam memberis then retracted proximally toward the home position as the feeder shoedistally advances a clip out of the barrel magazine toward the jaws ofthe clip applier into a pre-form position when the feeder shoe is 0.08″distal from the home position, for example. When the clip is in thepre-form position, the jaws can be partially opened by retracting thecam member slightly beyond the home position, i.e., the cam memberinteracts with the jaws of the clip applier to open the jaws when thecam member is retracted proximal to the home position, as discussedabove. Such an arrangement allows the clip to be expanded by thepre-form features on each of the jaws (i.e., protrusions 70608) asdiscussed above. The feeder shoe then distally advances the clip furtherinto a crimping position—0.3″ distal to the home position, for example.Once the feeder shoe is advanced beyond the barrel magazine (i.e., tothe pre-form position) the barrel magazine can be cycled (i.e., rotated)to position another clip for advancement into the jaws. The barrelmagazine is cycled by retracting the cam member to a fully retractedposition—0.05″ proximal to the home position, for example. The cycledclip will be biased against the feeder shoe which prevents the clip frombeing completely ejected from the barrel magazine. Once the feeder shoeis retracted to the home position the cycled clip can be displayed(i.e., the biasing member in the barrel magazine can now position thecycled clip into alignment with the feeder shoe because the feeder shoehas been retracted and is no longer blocking such movement). At thispoint a clip that has been pre-formed is positioned in the jaws andanother clip is aligned with the feeder shoe for deployment out of thebarrel magazine into the clip applier jaws, just as when the clipapplier was first inserted into the patient. The same operationsdiscussed above can be performed until all of the clips in the barrelmagazine are spent.

A graph 71200 of a firing member of a clip applier, such as any of theclip appliers described herein, for example, is illustrated in FIG. 358. The graph 71200 shows the relationship between the force required toadvance a clip within the clip applier (i.e., via the firing member)versus displacement. With further reference to FIG. 358 , a graph 71300of the same clip applier is illustrated showing the relationship betweenthe voltage applied to the motor driving the firing member of the clipapplier versus time. The motor controller of the clip applier canmonitor the current being drawn by the motor and/or the force beingapplied to the firing member by the motor to detect a clip feed jam, oran irregular force within the clip applier, and then prevent furtheradvancement of the firing member by implementing changes to the voltageapplied to electric motor, as seen in graph 71300. In other words, ifthe monitored force exceeds a threshold value, and/or the monitoredmotor current exceeds a threshold value, during the clip feed step, themotor controller can, one, reduce the magnitude of the voltage potentialbeing applied to the motor for a period of time and, two, further assessthe force within the firing system and/or further assess the electricalcurrent being drawn by the motor. If the force and/or motor currentcontinue to increase with the continued application of voltage to themotor, the motor control system can stop the motor and/or reverse thedirection of the motor shaft to retract the firing member through ashort stroke distance to clear the jammed clip. Once the jammed clip iscleared, the clip applier can return to its normal operation and preparethe next clip to be advanced in accord with the normal operatingsequence of the clip applier.

Other embodiments are envisioned where clearing the jammed clip isaccomplished by interrupting the normal sequence of the end effector jawoperations. More specifically, once the clip jam is detected the controlsystem of the clip applier (i.e., motor controller, processor, andmemory) could request the clinician initiate a jam removal actuation.The jam removal actuation results in the jaws of the clip applier beingopened further than normal prior to another attempt to re-advance theclip. During the attempt to re-advance the clip, the acceptable loadthreshold, i.e., the current threshold and/or the force threshold, couldbe elevated above the normal thresholds previously discussed to insurethe clip is ejected from the jaws. Once the jammed clip has beenejected, the clip applier could return to its normal operation andprepare the next clip to be advanced in accord with the normal operatingsequence of the clip applier.

As mentioned above, certain clip appliers can be loaded with clipshaving a first size and/or a second size. The relative size of the clipscan be measured using any suitable dimension, such as the leg-to-legwidth of the clips, for example. First clips having a first width can bewider than second clips having a second width. In various instances, theclip applier can be loaded with only first clips, only second clips, orboth first and second clips at the same time. In any event, clips havingdifferent sizes may deform differently for a given closure stroke of theclip jaws. Thus, for instance, a first closure stroke of the clip jawsmay be more preferable for the first clips while a second closure strokeof the clip jaws may be more preferable for the second clips. Many ofthe clip appliers disclosed herein are capable of selectively applyingmore than one closure stroke to the clip jaws; however, in order toapply the correct closure stroke to a clip, the clip applier needs to beable to assess which size of clip is positioned within the clip jaws. Incertain instances, such information can be manually entered into thecontrol system of the clip applier by the clinician. Such an arrangementis convenient when the clips in the clip applier all have the same size.In various instances, the clip cartridge attached to the clip appliercomprises a marker, such as a microchip, for example, which can beevaluated by the control system and/or a sensor circuit in communicationwith the control system, for example. Such an arrangement is convenientwhen the clips in the clip cartridge all have the same size.

In various instances, further to the above, the clip applier can beconfigured to assess the clip positioned between the clip jaws of theclip applier to assess the size of the clip. Once a clip is loadedbetween the clip jaws, the control system can partially operate the jawclosure drive and observe the force within the jaw closure drive and/orthe current drawn by the electric motor of the jaw closure drive. Thecontrol system is configured to compare the measured data to data storedin a memory device, for example, to assess whether the clip between theclip jaws is a first clip or a second clip, or any other clip. Forinstance, if the measured force and/or motor current follows a firstprofile, then the control system will determine that the clip is a firstclip and then apply the first closure stroke. Similarly, the controlsystem will apply the second closure stroke if the measured force and/ormotor current follows a second profile for the second clip. As such, thecontrol system can use the jaw closure drive to apply a short evaluationclosure stroke to assess the clip size and then complete the fullclosure stroke as appropriate. In at least one instance, the controlsystem can reset the jaw closure drive after performing the shortevaluation closure stroke and then complete a full closure stroke asappropriate. In various instances, it is envisioned that the shortevaluation closure stroke does not plastically deform, or at leastsubstantially plastically deform, the clip.

Referring to FIG. 359 , a graph 71400 of the force applied to a pair ofjaws of a clip applier versus time is illustrated. The control system ofthe clip applier can monitor the force within the crimping drive and/orthe electric current drawn by the motor to determine the amount of forceneeded to crimp a clip positioned within the jaws of the clip applier.This feedback force is initially dependent on the size and/or type ofclip that is within the jaws for a first portion of the closure strokeof the jaws. Once the size/type of clip is determined, the force appliedto the jaws of the clip applier can be adjusted for the remainder of thejaw closure stroke to crimp the clip with the proper amount of force.Such an arrangement is convenient when more than one size of clip hasbeen loaded into the clip applier. Other embodiments are envisionedwhere an adaptive control program change is initiated by the cartridgeidentifying itself to the clip applier upon insertion into the clipapplier. This allows the clip applier to update to the alternativecontrol program and thresholds (i.e., the forces applied to the jaws)for the size/type of clip loaded into the clip applier. Further, analternative to the identification of the cartridge could be thedetection of the loads needed to accomplish the first job of the clipapplier, which could be the advancement of a clip from the cartridge orpre-forming a clip within the jaws as discussed above. The first job ofthe clip applier may have a significantly higher load threshold neededto complete the operation and exceeding that threshold, or not, willthen determine the subsequent operations the clip applier and thethreshold limits of each operation.

Many of the clip appliers discussed herein have been discussed in thecontext that the clip jaws of the clip appliers are squeezed to crush aclip into its proper size. Other embodiments are envisioned in which aclip is elastically or resiliently stretched and then released once thetargeted tissue has been positioned within the stretched clip. Such anarrangement can be particularly useful when clamping or clipping bloodvessels, for example. In such instances, a clip can be released toresiliently return to, or at least toward, its unstretched position andclamp the blood vessel in an atraumatic, or a nearly atraumatic, manner.All of the clip appliers disclosed herein can be adapted to apply suchstretch-and-release clips. Moreover, further to the above, the clipappliers disclosed herein can be configured to apply both theclamp-to-crush clips and the stretch-and-release clips. Similar to theabove, the clip appliers would need to be able to identify the type ofclips contained therein in order to apply them properly to the patienttissue. Identification chips in the clip cartridges could be used forsuch purposes, for example.

FIG. 362 depicts a clip applier system 71500 in accordance with at leastone embodiment. The clip applier system 71500 comprises the clip applier70600 discussed above. The clip applier system 71500 further comprises amagnet aligned with one of the clips 70654 of the rotatable clipmagazine 70650. The clip applier system 71500 further comprises asensor, such as a Hall Effect sensor 71502, for example, fixedlypositioned within the ground portion 70612 of the clip applier 70600.The magnet can be sensed by the Hall Effect sensor 71502 and, based onthe voltage potential created by the Hall Effect sensor, the controlsystem of the clip applier 71500 can determine the radial location andorientation of the magnet and, thus, the radial location and orientationof the clip magazine 70650. When the magnet is in a first position71504, referring to FIG. 363 , the rotatable clip magazine 70650 isloaded with a full compliment of clips 70654 and one of the clips 70654can be advanced out of the rotatable clip magazine 70650 into the endeffector 70605. The rotatable clip magazine 70650 can then be cycled(e.g., rotated) as discussed above, causing the magnet to move betweenthe first position 71504 and a second position 71506. Another clip 70654can be advanced out of the rotatable clip magazine 70650 and therotatable clip magazine 70650 can be cycled again, causing the magnet tomove to a third position 71508. Another clip 70654 can be advanced outof the rotatable clip magazine 70650 and the rotatable clip magazine70650 can be cycled again, causing the magnet to move to a fourthposition 71510. Further, another clip 70654 can be advanced out of therotatable clip magazine 70650 and the rotatable clip magazine 70650 canbe cycled again, causing the magnet to move to a fifth position 71512.In the fifth position 71512, the last clip 70654 in the rotatable clipmagazine 70650 can be advanced out of the rotatable clip magazine 70650.Thus, the clip applier system 71500 can determine the status of the clipmagazine 70650 (i.e., the number of clips remaining) depending on theposition of the magnet relative to the Hall Effect sensor 71502. Furtherto the above, FIG. 363 depicts the voltage potential generated by theHall Effect sensor 71502 depending on the position of the magnet.

In at least one alternative embodiment of the clip applier system 71500,the clip magazine 70650 further comprises an extension member, or bar,that extends proximally from the clip magazine 70650 once all of theclips 70654 have been ejected from the clip magazine 70650. Theextension member is sensed by the Hall Effect sensor 71502 and/oranother electrical sensor within the clip applier 70600. When theextension member is detected by the clip applier system 71500, themechanical systems (i.e., the feeder member 70630, firing member 70640,and drive tube 70620) of the clip applier 70600 can be locked out toprevent further actuation.

FIG. 364 depicts a clip applier 71600. The clip applier 71600 comprisesa first jaw 71610 a and a second jaw 71610 b moveable relative to eachother between open and closed positions. The clip applier 71600 isconfigured to receive a clip 71604 which is crimped by the first jaw71610 a and the second jaw 71610 b when the first jaw 71610 a and thesecond jaw 71610 b are moved toward the closed position. The clipapplier 71600 comprises a resistive sensing circuit configured todetermine the position of the clip 71604 within the clip applier 71600.The resistive sensing circuit comprises a supply voltage source 71602which supplies current through a first lead 71620 a, the first jaw 71610a, the clip 71604, the second jaw 71610 b, and a Resistor 71620 b andback to a return 71606 where the current can be measured. When the clip71604 is moved distally though the clip applier, such as to the positionshown by clip 71604′, for example, the path through which the currentflows is larger (i.e., larger than the path for clip 71604) and theresistance within the path is greater and, as a result, the currentmeasured at the return 71606 will be smaller. Thus, the current measuredat the return 71606 is directly proportional to the position of the clip71604 within the clip applier 71600. The control system of the clipapplier is configured to use the magnitude of the current in thissensing circuit to assess the position of the clip 71604′ within thejaws 71610 a and 71610 b. Higher current magnitudes indicate that theclip 71604′ is more proximal and lower current magnitudes indicate thatthe clip 71604′s is more distal, while intermediate current magnitudesindicate that the clip 71604′ is positioned in the middle of the jaws71610 a and 71610 b.

Referring still to FIG. 364 , the clip applier 71600 further comprises asecond resistive sensing circuit configured to determine when the firstjaw 71610 a and the second jaw 71610 b are in the closed position. Morespecifically, the supply voltage supplies current which flows through afirst lead 71630 a connected to the first jaw 71610 a. The first lead71630 a is insulated from the first jaw 71610 a, i.e., it does not allowcurrent to flow into the first jaw 71610 a. When the first jaw 71610 aand the second jaw 71610 b are in the closed position, the first lead71630 a contacts a second lead 71630 b connected to the second jaw 71610b which allows current to flow into a resistor 71630 c and into thereturn 71606 where the current can be measured. The second lead 71630 bis also insulated from the second jaw 71610 b. Thus, when the first jaw71610 a and the second jaw 71610 b are in the closed position, thecontrol system, via the return, will sense a current determined by asecond resistance through the resistor 71630 c which indicates that thefirst and second jaws 71610 a, 71610 b are in the closed position. Thecontrol system may, at the same time, also sense the resistance throughresistor 71620 b which indicates the position of the clip 71604 withinthe clip applier 71600. Other embodiments are envisioned where only oneof the resistive sensing circuits discussed above are utilized with theclip applier 71600.

FIGS. 365 and 366 depict a variable resistance system for use with aclip applier 71650 configured to gather information (i.e., data) on theposition of the clip jaws and the formation of the clip during acrimping stroke. The clip applier 71650 is similar to clip applier71600, for example, in many respects. The clip applier 71650 comprises afirst jaw 71650 a and a second jaw 71650 b moveable relative to eachother between an open position (FIG. 365 ), a partially closed position(FIG. 366 ) and a closed position. The clip applier 71650 is configuredto receive a clip 71654 which is crimped by the first and second jaws71650 a, 71650 b when the first and second jaws 71650 a, 71650 b aremoved toward the closed position. The legs of the clip 71654 positionedwithin the first and second jaws 71650 a, 71650 b extend outwardly intoengagement with the first and second jaws 71650 a, 71650 b to ensure theclip 71654 is properly seated therebetween (i.e., so there is no slop orplay between the clip 71654 and the first and second jaws 71650 a, 71650b). In various instances, the legs of the clip are slightly deflectedinwardly when the clip is fed into the first and second jaws 71650 a,71650 b. The variable resistance system of the clip applier 71650 isdescribed in further detail below.

The variable resistance system comprises three return paths throughwhich an electrical current can flow and be sensed by the control systemof the clip applier in order to determine the position of the first andsecond jaws 71650 a, 71650 b relative to each other, and to sense theformation of the clip 71654. The first return path 71660 comprises thesecond jaw 71650 b. The second return path 71670 comprises a variableresistor configured to determine the position of the first jaw 71650 aand the second jaw 71650 b relative to each other. More specifically, asthe first jaw 71650 a and the second jaw 71650 b are moved from the openposition (FIG. 365 ) toward the closed position the resistance in thevariable resistor will change. The third return path 71680 comprisesanother variable resistor at the distal end of the second jaw 71650 bwhich is insulated from the second jaw 71650 b. When the first jaw 71650a and the second jaw 71650 b are in the open position (FIG. 365 ), theclip 71654 is in contact with the first return path 71660 and the thirdreturn path 71680. When the first jaw 71650 a and the second jaw 71650 nare in the partially closed position (FIG. 366 ), the clip 71654 is onlyin contact with the first return path 71660. When the first jaw 71650 aand the second jaw 71650 b are in the closed position the clip 71654 hasbeen fully crimped and is once again in contact with the first returnpath 71660 and the third path 71680. Throughout the movement of thefirst jaw 71650 a and the second jaw 71650 b between the open position,the partially closed position, and the closed position, the secondreturn path 71670 determines the position of the first jaw 71650 arelative to the second jaw 71650 b. Thus, the variable resistance systemcan determine jaw position and sense clip formation throughout the clipformation process by determining the resistance through each of thethree paths.

FIG. 367 depicts a clip applier jaw 71700 in accordance with at leastone embodiment. The clip applier jaw 71700 is configured to move towardand away from another clip applier jaw and is further configured tocrimp a clip as discussed above in relation to various embodimentsdisclosed herein. The clip applier comprises a proximal strain gauge71720 and a distal strain gauge 71730, and/or any number of suitablestrain gauges. The proximal strain gauge 71720 and the distal straingauge 71730 are positioned on a face 71710 of the clip applier jaw71700. Other embodiments are envisioned with more than two strain gaugesspaced along any suitable face of the clip applier jaw 71700 and/orbuilt into the clip applier jaw 71710 itself. The proximal strain gauge71720 is part of a proximal strain gauge circuit and generates a voltagesignal indicative of the strain within the clip applier jaw 71700 in afirst location and the distal strain gauge 71730 is part of a distalstrain gauge circuit and generates a voltage signal indicative of thestrain within the clip applier jaw 71700 in a second location. Theproximal and distal strain gauge circuits are in communication with thecontrol system of the clip applier and, as a clip is formed between theclip applier jaw 71700 and another clip applier jaw, different levels ofstrain will be detected by the control system at the first location andthe second location.

Referring to FIG. 368 , a graph 71800 of the strain (measured in Volts,but could be more conveniently illustrated in mV) within the proximalstrain gauge 71720 and the distal strain gauge 71730 at various stagesof clip formation is depicted. Upon the initial placement of a clipbetween the clip applier jaws, the clip legs of certain clips are biasedoutwardly into engagement with the jaws, as discussed above. In suchinstances, a larger strain may be measured in the proximal strain gauge71720 as compared to the distal strain gauge 71730. The difference inthe voltages within the strain gauges 71720, 71730 at this stage isvoltage A as depicted in FIG. 368 . As the jaws of the clip applierbegin to form the clip, the reading from the proximal strain gauge 71720will exceed a pre-formed strain threshold T_(PF) while the reading fromthe distal strain gauge 71730 remains below the pre-formed strainthreshold T_(PF). This can indicate that the clip has only been formedat or near the proximal strain gauge 71720. The difference in thevoltages between the readings of the strain gauges 71720, 71730, at thisstage, is measured to be A′. As the jaws of the clip applier form theclip further, the reading from the distal strain gauge 71730 willeventually exceed the pre-formed strain threshold T_(PF) and the readingfrom the proximal strain gauge 71720 will eventually exceed afull-formed strain threshold T_(FF). This can indicate that the clip hasbeen fully formed at or near the proximal strain gauge 71720 and hasbegun to be deformed at or near the distal strain gauge 71730. When thereadings from the proximal strain gauge 71720 and the distal straingauge 71730 are both measured to be beyond the full-formed thresholdT_(FF) and the pre-formed threshold T_(PF), respectively, the differencein the strain gauge readings is measured as A″ as depicted in FIG. 368 .Further, as the jaws of the clip applier form the clip further, thereading from the distal strain gauge 71730 will eventually exceed thefull-formed strain threshold T_(FF) and the reading from the proximalstrain gauge 71720 will continue to increase above the full-formedstrain threshold T_(FF). When the reading from the proximal strain gauge71720 and the distal strain gauge 71730 are measured to both be beyondthe full-formed threshold T_(FF), the difference in the strain gaugereadings is measured as A′″ as depicted in FIG. 368 .

Further to the above, the state of the clip can be determined bymeasuring the differences between the readings of the proximal straingauge 71720 and the distal strain gauge 71730 throughout the formationof a clip. More specifically, a difference in voltage measuring Aindicates that the clip has yet to be deformed. A difference in voltagemeasuring A′ indicates that only a proximal portion of the clip has beendeformed. A difference in voltage measuring A″ indicates that theproximal portion of the clip has been fully formed and the distalportion of the clip has begun to be deformed. And lastly, a differencein the voltage measuring A′″ indicates that both the proximal and distalportions of the clip have been fully formed.

As discussed above, a clip applier is often inserted into a patientthrough a trocar. As a result, the diameter of the passageway throughthe trocar dictates a lot of the design considerations of the clipapplier—especially of the portions of the clip applier that are insertedthrough and/or into the trocar passageway. That said, there is oftenmotivation to make trocars as narrow as possible to reduce the size ofthe incisions in the patient, among other reasons. As such, narrowtrocars, and narrow trocar passageways, present significant designconstraints and often limit the widths of the clips that can be used.With this in mind, clip appliers are disclosed herein which areconfigured to store the clips in a small configuration and then enlargethe clips once they are on the other side of the trocar. Such anarrangement can allow clips to be used which, in their enlarged state,exceed the diameter of the trocar that they were inserted through.

FIGS. 369 and 370 depict a clip applier 71900 in accordance with atleast one embodiment. The clip applier 71900 comprises a first jaw 71910a and a second jaw 71910 b moveable relative to each other about a pivotpin 71912 between a closed position, a home position (FIG. 369 ), and anopen position (FIG. 370 ). The clip applier 71900 further comprises acam member 71920 configured to move the first jaw 71910 a and the secondjaw 71910 b between the closed position, the home position, and the openposition. More specifically, the first jaw 71910 a and the second jaw71910 b are moved to the open position by the cam member 71920 when thecam member 71920 is moved to a fully retracted position (FIG. 370 ) dueto the cam member 71920 engaging a first jaw cam 71914 a on the firstjaw 71910 a and a second jaw cam 71914 b on the second jaw 71910 b.Furthermore, the first jaw 71910 a and the second jaw 71910 b are movedto the home position by the cam member 71920 when the cam member 71920is moved distally to a home position depicted in FIG. 369 (i.e., the cammember 71920 is no longer engaging the first jaw cam 71914 a and thesecond jaw cam 71914 b allowing the first jaw 71910 a and the second jaw71910 b to assume the home position). Further still, the first jaw 71910a and the second jaw 71910 b are moved to the closed position by the cammember 71920 when the cam member 71920 is moved distally to a fullyadvanced position due to the cam member 71920 cammingly engaging theouter surfaces of the first jaw 71910 a and the second jaw 71910 b. Thefirst jaw 71910 a and the second jaw 71910 b are configured to receive aclip 71904 therein to be expanded during a pre-form operation andcrimped during a crimping operation. FIG. 369 depicts the clip 71904 ina storage configuration when the first jaw 71910 a and the second jaw71910 b are in the home position. The clip 71904 can be a 5 mm clip inthe storage configuration, for example. Expansion of the clip 71904during the pre-form operation and crimping of the clip 71904 during thecrimping operation are described in further detail below.

The first jaw 71910 a and the second jaw 71910 b comprise pre-formingfeatures, or protrusions 71930 a and 71930 b, similar to protrusions70126 a and 70126 b discussed above. The protrusions 71930 a and 71930 bengage the inner surfaces of the clip 71904 and expand the clip 71904from the storage configuration (FIG. 369 ) to a firing configuration(FIG. 370 ) when the first jaw 71910 a and the second jaw 71910 b aremoved to the open position. For example, the clip 71904 is expanded fromthe storage configuration where the clip 71904 has an approximately 5 mmwidth to a firing configuration where the clip 71904 has anapproximately 10 mm width. That said, a clip can have any suitablestored width and any suitable expanded width. After the clip 71904 hasbeen expanded to the firing configuration, a firing member advances theclip over the protrusions 71930 a, 71930 b into a crimping positionwithin the first jaw 71910 a and the second jaw 71910 b. The protrusions71930 a and 71930 b comprise angled portions which allow the clip 71904to slide over the protrusions 71930 a and 71930 b when advanced by thefiring member. Once a clip is in the crimping position, the cam member71920 is advanced distally to the fully advanced position during acrimping stroke to move the first jaw 71910 a and the second jaw 71910 bto the closed position, and, thus, crimp the clip 71904 within thecrimping chamber.

Further to the above, the clip applier 71900 further comprises a sensorarray 71940 that detects a magnet 71950 included in one of the first jaw71910 a and the second jaw 71910 b. The sensor array 71940 detects thelocation of the magnet 71950 relative to the sensor array 71940 in orderto determine the position of the first jaw 71910 a and the second jaw71910 b relative to each other during the operation of the clip applier71900.

As discussed herein, clip appliers are loaded with clips in a variety ofmanners. For instance, clips can be loaded into a clip applier by way ofa clip cartridge. Such clip cartridges can comprise clips stacked alonga longitudinal axis, for example. Such clip cartridges can also compriseclips stacked along an axis which is transverse to the longitudinal axisof the clip applier. Certain cartridges are stored in a circumferentialconfiguration, as described above. That being said, some clip appliersmay be configured to hold only one clip at a time. The teachingsprovided herein are adaptable to such clip appliers. In at least oneinstance, a one-clip clip applier, for example, can be used with adocking station comprising a plurality of clips stored therein. In suchinstances, the clinician can use the docking station to re-supply a clipto the one-clip clip applier after each use of the clip applier. Incertain instances, the docking station can be positioned in the patientwhich prevents the need to remove the clip applier from the patient suchthat the clip applier can be reloaded. In at least one instance, asdiscussed below, the docking station can be attached to a trocarinserted into the patient, for example. The above being said, the ideaof a docking station positioned within a patient can also be used with amulti-clip clip applier. In such instances, one or more clips from thedocking station can be loaded into the multi-clip clip applier withouthaving to remove the clip applier from the patient.

Turning to FIGS. 371 and 372 , a clip applier system 72000 is depicted.The clip applier system comprises a trocar 72010, a clip magazine 72050,and a clip applier 72020. The clip applier 72020 comprises an elongateshaft 72011 extending from a housing, an articulation joint 72022extending from the elongate shaft 72011, and an end effector 72024extending from the articulation joint 72022. The end effector 72024comprises a first jaw 72024 a and a second jaw 72024 b moveable relativeto each other between an open position and a closed position. The endeffector 72024 is articulable relative to the elongate shaft 72011 aboutthe articulation joint 72022. The clip magazine 72050 comprises anopening 72051 (see FIG. 371 ) through the clip magazine 72050. Prior toinsertion of the clip applier 72020 through the trocar 72010, the clipmagazine 72050 is positioned within the patient and attached to thedistal end of the trocar 72010. The opening 72051 allows the clipmagazine 72050 to be received and attached to the distal end of thetrocar 72010 as depicted in FIG. 372 . The clip magazine 72050 can bethreadably attached to the distal end of the trocar 72010, for example.The clip applier 72020 is then inserted through the trocar 72010 and theopening 72051 of the clip magazine 72050 until the end effector 72024 ofthe clip applier 72020 is positioned distal to the clip magazine 72050.As the clip applier 72020 is retracted toward the clip magazine 72050,the clip applier 72020 engages the clip magazine 72050 to eject a clipfrom the clip magazine 72050 into the end effector of the clip applier72020, as discussed in greater detail below.

Turning to FIGS. 376 and 377 , the clip magazine 72050 furthercomprises, a leaf spring 72052, a plurality of clips 72054 removablystored in the clip magazine 72050, a spring 72059, a sled 72058, and aloading arm 72056. The leaf spring 72052 prevents the clips 72054 fromfalling out of the clip magazine 72050 inadvertently. The spring 72059biases the sled 72058 distally to bias the clips 72054 toward theloading arm 72056. The loading arm 72056 grasps and holds a clip 72054in place until acted upon by the clip applier 72020. To this end, theloading arm 72056 engages a jaw wing 72026 of the clip applier 72020 asthe clip applier 72020 is retracted towards the clip magazine 72050(i.e., proximally). When the jaw wing 72026 is engaged by the loadingarm 72056, the jaw wing 72026 moves proximally and the loading arm 72056rotates toward the end effector 72024 to load a clip 72054 from the clipmagazine 72050 into the end effector 72024 of the clip applier 72020.FIGS. 373-375 depict the movements of the jaw wing 72024 and the loadingarm 72056 as the clip applier 72020 is retracted towards the clipmagazine 72050. After a clip 72054 has been loaded into the end effector72024, the clip applier 72024 can be moved distally to a desiredlocation within the patient to crimp the clip 72054 around patienttissue. After the clip 72054 is crimped and released, the clip applier72020 can be retracted toward the clip magazine 72050 (i.e., proximally)to engage the jaw wing 72026 with the loading arm 72056 of the clipmagazine 72050 to load another clip into the clip applier 72020. Thisprocess can be repeated until all of the clips 72054 have been depletedfrom the clip magazine 72050, and/or until a suitable number of clipshave been applied.

Turning now to FIGS. 378 and 379 , the relationship between the jaw wing72026 and the first and second jaws 72024 a and 72024 b of the clipapplier 72020 is depicted. The jaw wing 72026 is operably engaged withthe first and second jaws 72024 a and 72024 b such that, when the firstand second jaws 72024 a and 72024 b are in the closed position (FIG. 379), the jaw wing 72026 is retracted. To this end, the clip applier 72020can be inserted through the clip magazine 72050 without the jaw wing72026 engaging the loading arm 72056 of the clip magazine 72050. Otherembodiments are envisioned where the clip applier 72020 engages the clipmagazine 72050 to load a clip 72054 into the end effector 72024 when theclip applier 72020 is moved from a proximal position behind the clipmagazine 72050 to a distal position beyond the clip magazine 72050.

A clip applier 73000 is depicted in FIGS. 380-383 . The clip applier73000 comprises an elongate shaft 73010 extending from a housing, anarticulation joint 73020 extending from the elongate shaft 73010, amagazine housing 73030 extending from the articulation joint 73020, andan end effector 73040 extending from the magazine housing 73030. The endeffector 73040 comprises a first jaw 73040 a and a second jaw 73040 bmoveable relative to each other between an open position and a closedposition. The magazine housing 73030 comprises a bottom housing 73030 band a top housing 73030 a. The top housing 73030 a is movable relativeto the bottom housing 73030 b between an open position (FIG. 380 ) and aclosed position (FIG. 382 ) about a pivot pin 73032 attached to thearticulation joint 73020. The magazine housing 73030 can receive a clipmagazine 73050 comprising a plurality of clips 73054 stored therein. Theclips 73054 are loaded into the clip magazine 73030 and are locked inplace by a biasing member, or leaf spring 73056. The leaf spring 73056prevents the clips 73054 from being ejected form the clip magazine 73050until the clip magazine 73050 is seated in the magazine housing 73030,as discussed in greater detail below.

The clip magazine 73050 further comprises notches 73058 on either sideof the clip magazine 73050. To properly seat the clip magazine 73050 inthe magazine housing 73030, the notches 73058 of the clip magazine 73050are aligned with protrusions 73034 of the magazine housing 73030 to seatand align the clip magazine 73050 in the magazine housing 73030 asdepicted in FIG. 381 . Once the clip magazine 73050 is installed intothe magazine housing 73030, the top housing 73030 a can be moved to theclosed position as depicted in FIG. 382 . The top housing 73030 acomprises a lockout release, or protrusion 73032, that engages the leafspring 73056 of the clip magazine 73050 when the clip magazine 73050 isinstalled in the magazine housing 73030 and the top housing 73030 a isin the closed position as depicted in FIG. 383 . When the leaf spring73056 is depressed by the protrusion 73032, the clips 73054 are nolonger locked into position within the clip magazine 73050 and can beejected from the clip magazine 73050 into the end effector 73040 by afiring member.

Turning now to FIGS. 384-387 , after all of the clips 73054 have beenejected from the clip magazine 73050, the clip magazine 73050 can belocked out when removed from the magazine housing 73030 to prevent theclip magazine 73050 from being re-installed into the magazine housing73030 until reloaded with at least one new clip 73054. Morespecifically, the clip magazine 73030 comprises a sled 73052 that movesthrough the clip magazine 73030 as the clips 73054 are ejected. The sled73052 comprises spring loaded detents 73059 which align with the notches73058 in the clip magazine 73050 when the last clip 73054 has beenejected form the clip magazine 73050. When the clip magazine 73050 isinstalled in the magazine housing 73030 and the clip magazine 73050 hasbeen spent, the spring loaded detents 73059 are biased against theprotrusions 73034 as depicted in FIGS. 385 and 387 . After the clipmagazine 73050 is removed from the magazine housing 73030, the springloaded detents 73059 protrude through the notches 73058 to lock the sled73052 into place as depicted in FIG. 384 . The spent clip magazine 73050cannot be re-installed into the magazine housing 73030 unless at leastone clip 73054 is loaded into the clip magazine 73050. Morespecifically, until the sled 73052 is retracted to disengage the springloaded detents 73059 from the notches 73058 (i.e., at least one clip73054 is installed) the clip magazine 73050 cannot be installed into themagazine housing 73030 because the spring loaded detents 73059 occupythe notches 73058 and will not allow the notches 73058 to properly alignand seat with the protrusions 73034 of the magazine housing 73030.

Other embodiments are envisioned where a clip applier system comprises aclip applier, a trocar, and a sensing system. The clip applier of theclip applier system is similar to clip applier 72020 in many respectsand the trocar is similar to the trocar 72010 in many respects. Thetrocar can comprise a sensor, such as a Hall Effect sensor, for example,attached to, or near, the distal end of the trocar. The clip applierfurther comprises a detectable element, such as a magnet, for example,positioned in the end effector of the clip applier. The magnet in theend effector of the clip applier and the Hall Effect sensor on thedistal end of the trocar are included in the sensing system. The sensingsystem is in signal communication with the control system of the clipapplier via a wireless signal transmitter in the trocar and a wirelesssignal receiver in the clip applier. The control system of the clipapplier is configured to automatically control the opening and closingof the jaws of the end effector depending on the position of the magnetrelative to the Hall Effect sensor. More specifically, when the magnetin the jaws is positioned a predetermined distance distal to the HallEffect sensor of the trocar—which indicates that the jaws have passedthrough the trocar, the clip jaws are automatically moved to an openposition by the control system of the clip applier. Moreover, thecontrol system of the clip applier can also automatically load a clipinto the open jaws. Such an arrangement reduces the time needed to loadthe clip applier after being inserted into a patient. Further, when themagnet in the jaws is approaching the Hall Effect sensor of the trocarfrom a distal position (i.e., the clip applier is being retractedproximally toward the trocar) the control system automatically moves thejaws to a closed position to allow the clip applier to be retractedthrough the trocar.

FIG. 388 depicts a clip applier 74000 in accordance with at least oneembodiment. The clip applier 74000 comprises an elongate shaft 74010extending from a housing, a clip reload 74020 comprising a plurality ofclips, a distal head 74030 rotatable relative to the housing, an endeffector 74040 extending from the distal head 74030, and an articulationjoint 74050 rotatably connecting the distal head 74030 and the elongateshaft 74010. The distal head 74030 is articulatable relative to theelongate shaft 74010 by an articulation bar 74052 that is operablyresponsive to a motor inside the housing of the clip applier 74000.Further, the clip reload 74020 is releasably attachable to the distalhead 74030 by way of an opening 74032 in the distal head 74030 and aprotrusion 74022 on the clip reload 74020. The protrusion 74022 extendsoutwardly and is captured by the opening 74032 to releasably attach theclip reload 74020 to the distal head 74030. The clip reload 74020 isinterchangeable with other clip reloads, for instance, the clip reload74020 can be interchanged with clip reloads containing clips that aresmaller or larger than the clips of clip reload 74020. This arrangementallows for different size clip reloads to be attached to the same distalhead, such as the distal head 74030, for example.

FIGS. 389 and 390 depict a distal head 74100 releasably attached to ashaft 74120 of a clip applier in accordance with at least oneembodiment. The distal head 74100 has an eight millimeter diameter andis for use with LIGAMAX 5 clips from Ethicon Inc. and the shaft 74120has an eight millimeter diameter shaft, for example. The distal head74100 is releasably attachable to the shaft 74120 by a detent 74105.Other embodiments are envisioned with different attachment mechanisms.The distal head 74100 comprises a proximal portion 74110 which extendsproximally from the distal head 74100 and comprises the detent 74105thereon. The proximal portion 74110 is configured to fit inside andalign with the shaft 74120 of the clip applier to facilitate properattachment of the distal head 74100 to the shaft 74120.

FIGS. 391 and 392 depict a distal head 74200 releasably attached to ashaft 74220 of a clip applier in accordance with at least oneembodiment. The distal head 74200 has a nine millimeter diameter and isfor use with ER320 clips from Ethicon Inc. and the shaft 74220 has aneight millimeter shaft diameter. The distal head 74200 is releasablyattachable to the shaft 74220 by a detent 74205. The distal head 74200comprises a proximal portion 74210 which extends proximally from thedistal head 74200 and comprises the detent 74205 thereon. The proximalportion 74210 is configured to fit inside and align with the shaft 74220of the clip applier to facilitate proper attachment of the distal head74200 to the shaft 74220.

FIGS. 393 and 394 depict a distal head 74300 releasably attached to ashaft 74320 of a clip applier in accordance with at least oneembodiment. The distal head 74300 is an eleven millimeter distal clipapplier head for use with ER420 clips and the shaft 74320 is an eightmillimeter shaft, for example. The distal head 74300 is releasablyattachable to the shaft 74320 by a detent 74305. The distal head 74300comprises a proximal portion 74310 which extends proximally from thedistal head 74300 and comprises the detent 74305 thereon. The proximalportion 74310 is configured to fit inside and align with the shaft 74320of the clip applier to facilitate proper attachment of the distal head74300 to the shaft 74320.

The distal heads 74100, 74200, and 74300 are of varying sizes asdescribed above, however, the distal heads 74100, 74200, and 74300 arereleasably attachable to the same size shaft (an eight millimeter shaft,for example).

FIG. 395 depicts a clip applier system 74400 in accordance with at leastone embodiment. The clip applier system 74400 comprises a clip appliershaft 74410 extending from a housing of the clip applier system 74400.The clip applier shaft 74410 is configured to selectively receivevarious distal heads, such as distal head 74450, or in the alternativedistal head 74460, for example. The clip applier shaft 74410 comprises aproximal shaft 74412 extending from the housing of the clip applier, adistal shaft 74420 comprising an opening 74422, and an articulationjoint 74415 connecting the proximal shaft 74412 and the distal shaft74420. The opening 74422 is configured to receiver protrusions 74452,74462 of the distal heads 74450 and 74460, respectively, depending onwhich distal head is attached to the clip applier shaft 74410. In atleast one embodiment, the distal heads 74450 and 74460 are differentsizes (e.g., in diameter and/or length) and are configured to storedifferent size clips, for example. Further, the distal head 74450comprises an end effector 74454 extending therefrom and the distal head74460 comprises end effector 74464 extending therefrom which havedifferent sizes and can form clips to different sizes. As a result ofthe above, the clip applier system 74400 comprises a clip applier shaft74410 configured to interchangeably connect different size distal headswith different size end effectors to the same size clip applier shaft74410.

FIG. 396 depicts a clip applier system 74470 in accordance with at leastone embodiment. The clip applier system 74470 comprises a distal head74472 configured to releasably attach to a shaft 74478 comprising arotary input 74479. The shaft 74478 extends from a housing of the clipapplier system 74470 and is operably responsive to rotary motionsgenerated by a motor within the housing. The distal head comprises acarriage 74474 and a drive screw 74477 threadably engaged with thecarriage 74474. The carriage 74474 is configured to translate relativeto the distal head 74472 when the distal head 74472 is attached to theshaft 74478. More specifically, the drive screw 74477 is threadablyengaged with a collar 74476 of the carriage 74474 and the carriage 74474is rotatably constrained within the distal head 74472 such that, as thedrive screw 74477 is rotated, the carriage 74474 will translate throughthe distal head 74472. The rotary input 74479 is configured to connectto the drive screw 74477 via a quick disconnect 74475 on the distal endof the rotary input 74479 when the distal head 74472 and the shaft 74478are brought together. Thus, the rotary input 74479 can rotate the drivescrew 74477 when they are attached. In at least one embodiment, theproximal end of the drive screw 74477 comprises a square shape (see FIG.398 ) and the distal end of the rotary input 74479 comprises a squareopening configured to receive the square shape of the drive screw 74477to allow the transfer of rotational motions from the rotary input 74479to the drive screw 74477. Other embodiments are envisioned withdifferent mechanical connection types between the rotary input 74479 anddrive screw 74477 to allow the distal head 74472 and shaft 74478 toreleasably attach and rotate together.

Once the distal head 74472 is attached to the shaft 74478, the rotaryinput 74479 can be rotated to translate the carriage 74474 between aproximal position and a distal position within the distal head 74472.The thread pitch of the drive screw 74477 can be chosen to effectuate atranslation of the carriage 74474 through a stroke of a predeterminedlength. The predetermined length can be based on the distal headfunction that the translation of the carriage 74474 is performing, suchas feeding a clip through the distal head into an end effector orcrimping a clip within the end effector, for example. Further, thepredetermined length can be selected based on the size (e.g., diameteror length) of the distal head and/or the size of the clips to beadvanced and/or formed.

FIG. 397 depicts a clip applier system 74480 in accordance with at leastone embodiment. The clip applier system 74480 is similar to the clipapplier system 74470 in many respects. The distal head 74482 comprises acarriage 74484 rotatably constrained within the distal head 74482, andthe carriage 74484 comprises a collar 74486 configured to capture adrive screw 74487 of the distal head 74482. The drive screw 74487 isconfigured to releasably attach to the rotary input 74479 of the shaft74478 of the clip applier system 74470, similar to the above. Asillustrated in FIG. 397 , the distal head 74482 is larger than thedistal head 74472; however, the carriage 74484 of the distal head 74482is sized such that the drive screw 74487 and rotary input 74489 arealigned when the distal head 74482 is attached to the shaft 74478. Thus,the quick disconnect 74475 of the clip applier system 74470 iscompatible with the drive screw 74487 of the clip applier system 74480.Similar to the drive screw 74477 of the clip applier system 74470, thethread pitch of the drive screw 74487 can be selected to effectuate atranslation of the carriage 74484 through a stroke of a predeterminedlength. The predetermined length can be based on the distal headfunction that the translation of the carriage 74484 is performing, suchas feeding a clip through the distal head 74482 into an end effector orcrimping a clip within the end effector, for example. Further, thepredetermined length can be selected based on the size (e.g., diameterand/or length) of the distal head and/or the size of the clips to beadvanced or formed.

FIG. 399 depicts a clip magazine 74500 of a clip applier in accordancewith at least one embodiment. The clip magazine 74500 is rotatable abouta magazine axis MA. The clip magazine 74500 is configured to removablestore a plurality of clips, such as inner clips 74501, 74503, 74505 andouter clips 74502, 74504, 74506, for example. The clip magazine 74500comprises an outer housing 74510 with the plurality of clips removablystored therein. The clips are arranged in a radial array and spacedapproximately 120 degrees apart around the magazine axis MA. Further,the outer clips 74502, 74504, and 74506 are closest to the outer housing74510 and the inner clips 74501, 74503, 74505 are closest to themagazine axis MA. Each outer clip 74502, 74504, and 74506 is laterallyoffset from, and stacked on top of, a respective inner clip 74501,74503, and 74505. Each outer clip 74502, 74504, 74506 is centered on aclip axis CA, the clip axes CA are approximately 120 degrees apart, andeach inner clip 74501, 74503, 74505 is offset from its respective clipaxis CA. For example, the outer clip 74502 is stacked on top of theinner clip 74501, and the edges of the outer clip 74502 are offset fromthe edges of the inner clip 74501 (the outer clip 7502 is centered onthe clip axis CA and inner clip 74501 is not). When this arrangement isduplicated with the clip stacks at each 120 degree location, asillustrated in FIG. 399 , the outer housing 74510 is smaller than a cliparrangement where the clip stacks are not offset, such as in FIG. 400 ,for example. In other words, if the clips are stacked on top of oneanother with no lateral offset then the radial footprint of the clipswill be larger, absent other considerations. Other embodiments of cliparrangements within a clip magazine are envisioned and described below.

FIG. 400 depicts a clip magazine 74550 in accordance with at least oneembodiment. The clip magazine 74550 is configured to attach to and/orfit inside a clip applier shaft 74552 and is rotatable relative to theclip applier shaft 74552. The clip magazine 74550 comprises a pluralityof clips 74554 arranged in stacks and stored in the clip magazine 74550at storage locations 74556 that are radially spaced approximately 120degrees apart, for example. The storage locations 74556 are sized tokeep the edges of the clips 74554 aligned with one another. An opening74558 in the clip magazine 74550 allows an internal drive to passthrough the clip magazine 74550. The internal drive can advance a clip74554 out of the clip magazine 74550 into an end effector of the clipapplier and/or crimp a clip 74554 positioned in the end effector of theclip applier. Other embodiments are envisioned where more than oneinternal drive extends through the opening 74558, for example. The clips74554 are the same size; however, in at least one alternativeembodiment, the clips 74554 positioned at each storage location 74556are different sizes, for example. Further, in at least one alternativeembodiment, the clip size can vary between storage locations 74556, forexample. The clip applier shaft 74552 comprises a loading slot 74559configured to receive a clip 74554 when one of the storage locations74556 is aligned with the loading slot 74559. In at least oneembodiment, biasing members 74557 are configured to bias the clips 74554from the clip magazine 74550 into the loading slot 74559.

FIG. 401 depicts a clip magazine 74560 in accordance with at least oneembodiment. The clip magazine 74560 is configured to attach to and/orfit inside a clip applier shaft 74562 and is rotatable relative to theclip applier shaft 74562. The clip magazine 74560 comprises a pluralityof clips 74564 arranged in stacks and stored in the clip magazine 74560at storage locations 74566 that are radially spaced approximately 120degrees apart. The storage locations 74566 are angled to offset theedges of the clips 74564 and each storage location 74566 stores multipleclips 74564. An opening 74568 in the clip magazine 74560 allows aninternal drive of a clip applier to pass through the clip magazine74560. The internal drive can advance a clip 74564 out of the clipmagazine 74560 into an end effector of the clip applier and/or crimp aclip 74564 positioned in the end effector. Other embodiments areenvisioned where more than one internal drive extends through theopening 74568. The clips 74564 are the same size; however, in at leastone alternative embodiment, the clips 74564 positioned at each storagelocation 74566 are different sizes. In at least one alternativeembodiment, the clip size can vary between storage locations 74566, forexample. The clip applier shaft 74562 comprises a loading slot 74569configured to receive a clip 74564 when one of the storage locations74566 is aligned with the loading slot 74569. Biasing members 74567 areconfigured to bias the clips 74564 from the clip magazine 74560 into theloading slot 74569.

FIG. 402 depicts a clip magazine 74570 in accordance with at least oneembodiment. The clip magazine 74570 is configured to attach to and/orfit inside a clip applier shaft 74572 and is rotatable relative to theclip applier shaft 74572 about a magazine axis MA. The clip appliershaft 74572 defines a shaft axis SA. Further, the clip magazine 74570comprises a plurality of clips 74574 arranged in stacks and stored inthe clip magazine 74570 at storage locations 74576 that are radiallyspaced approximately 120 degrees apart. The storage locations 74576 aresized to keep the edges of the clips 74574 aligned and each storagelocation 74576 stores multiple clips 74574. The magazine axis MA isoffset from the shaft axis SA; thus, the diameter of the clip magazine74570 is reduced (as compared to the clip magazine 74550) to provideample storage for the clips 74574. Therefore, in at least oneembodiment, the storage locations 74576 are closer together than storagelocations 74556 of clip magazine 74550. The clip magazine 74570 works inconjunction with external drivers configured to advance the clips 74574out of the clip magazine 74570 and/or crimp a clip 74574 positioned inan end effector of a clip applier. In at least one embodiment, the clips74574 positioned at each storage location 74576 are different sizes. Inat least one alternative embodiment, the clip size can vary betweenstorage locations 74576.The clip applier shaft 74572 comprises a loadingslot 74579 configured to receive a clip 74574 when one of the storagelocations 74576 is aligned with the loading slot 74579. Biasing members74577 are configured to bias the clips 74574 from the clip magazine74570 into the loading slot 74579.

FIG. 403 depicts a clip magazine 74580 in accordance with at least oneembodiment. The clip magazine 74580 is configured to attach to and/orfit inside a clip applier shaft 74582 and is rotatable relative to theclip applier shaft 74582 about a magazine axis MA. The clip appliershaft 74852 defines a shaft axis SA. The clip magazine 74580 comprises aplurality of clips 74584 arranged in stacks and stored in the clipmagazine 74580 at storage locations 74586 that are radially spacedapproximately 120 degrees apart. The storage locations 74586 are sizedto keep the edges of the clips 74584 aligned and each storage location74586 stores multiple clips 74584. The magazine axis MA is offset fromthe shaft axis SA; thus, the diameter of the clip magazine 74580 isreduced (as compared to the clip magazine 74550) to provide amplestorage for the clips 74574. Therefore, in at least one embodiment, thestorage locations 74586 are closer together than storage locations 74556of clip magazine 74550, for example. The clip magazine 74580 works inconjunction with an external drive configured to advance a clip 74584out of the clip magazine 74580. Further, the clip magazine 74580 isconfigured to protrude through an opening 74589 in the clip appliershaft 74582 which provides additional space for the clip magazine 74580relative to the clip applier shaft 74582. In at least one embodiment,the clips 74584 positioned at each storage location 74586 are differentsizes. In at least one alternative embodiment, the clip size can varybetween storage locations 74586. The clip applier shaft 74582 comprisesa loading slot 74581 configured to receive a clip 74584 when one of thestorage locations 74586 is aligned with the loading slot 74581. Biasingmembers 74587 are configured to bias the clips 74584 from the clipmagazine 74580 into the loading slot 74581.

FIG. 404 depicts a clip magazine 74590 in accordance with at least oneembodiment. The clip magazine 74590 is configured to attach to and/orfit inside a clip applier shaft 74592 and is rotatable relative to theclip applier shaft 74592. The clip magazine 74590 comprises a pluralityof clips 74594 arranged in stacks and stored in the clip magazine 74590at storage locations 74596 that are radially spaced approximately 90degrees apart. The storage locations 74596 are sized to keep the edgesof the clips 74594 aligned and can store multiple clips in eachlocation, for example. The clips 74594 are the same size; however, in atleast one alternative embodiment, the clips 74594 positioned at eachstorage location 74596 are different sizes. In at least one alternativeembodiment, the clip size can vary between storage locations 74596. Theclip magazine 74590 is rotated using a gear and tooth arrangement 74591.More specifically, the clip magazine 74590 further comprises acircumferential rack of teeth 74593 that extends between the storagelocations 74596. The circumferential rack of teeth 74593 is operablyengaged with a rotatable drive shaft 74599 of a clip applier. Therotatable drive shaft 74599 comprises a gear 74598 fixed thereto whichis engaged with the circumferential rack of teeth 74593. Thus, as therotatable drive shaft 74599 rotates, the clip magazine 74590 rotatesrelative to the clip applier shaft 74592. The clip applier shaft 74592comprises a loading slot 74595 configured to receive a clip 74594 whenone of the storage locations 74596 is aligned with the loading slot74595. Biasing members 74597 are configured to bias the clips 74594 fromthe clip magazine 74590 into the loading slot 74595.

FIG. 405 depicts a clip magazine 74600 in accordance with at least oneembodiment. The clip magazine 74600 is configured for use with a clipapplier and the clip magazine 74600 is configured to store a pluralityof clips 74610. The clips 74610 are arranged in the clip magazine 74600in a clip stack and are held in the clip magazine 74600 by a clipchannel 74620 that is angled laterally relative to the radius of theclip magazine 74600. The clip channel 74620 partially mimics the shapeof the clips 74610 in the clip stack in order to hold the clips 74610into the clip magazine 74600. More specifically, the clip channel 74620provides space for the clips 74610 to slide relative to the clip channel74620 at discrete locations and at other discrete locations the clipchannel 74620 releasably holds the clips 74610 in place. For example,the clip channel 74620 can comprises discrete holding locations 74630and 74640 to hold the clips 74610 in place. The discrete holdinglocations 74630, 74640 provide for a tighter fit between the clips 74610and the clip channel 74620 as compared to the rest of the clip channel74620. The discrete holding locations 74630, 74640, along with theangled clip channel 74620, maintain the clips 74610 in the clip magazine74600 until the clips 74610 are ejected.

FIGS. 406 and 407 depict a clip magazine 74700 in accordance with atleast one embodiment. The clip magazine 74700 is configured to beattached to and/or fit inside a shaft 74720 of a clip applier, forexample. The shaft 74720 defines a shaft axis SA. The clip magazine74700 comprises a carriage 74710 comprising a plurality of clip holders74712 configured to store a plurality of clips 74714. The clip holders74712 extend from the driven portion of the carriage 74710 such that theplurality of clips 74714 are positioned distal to the carriage 74710.The clip magazine 74700 is configured to rotate relative to the shaft74720 about the shaft axis SA between a plurality of clip firingpositions (FIG. 406 ) and a plurality of clip loading positions (FIG.410 ). The clip magazine 74700 is rotatable via a rotary input 74726which is operably responsive to a motor of a clip applier. As the clipmagazine 74700 is rotated, the clips 74714 are configured to be biasedinto a clip track 74716 of the shaft 74720 when the clip magazine 74700is in a loading position, as illustrated in FIG. 410 . A clip 74714positioned in the clip track 74716 is configured to be advanced into anend effector of the clip applier by a feeder shoe 74724 when the clipmagazine 74700 is in a firing position, as illustrated in FIG. 406 .Other embodiments are envisioned where the clip track 74716 is part ofthe clip magazine 74700 and is aligned with another clip track in theshaft 74720 to facilitate the stripping and advancement of clips 74714from the clip magazine 74700, for example.

Further to the above, each clip holder 74712 stores two clips 74714.Other embodiments are envisioned where each clip holder 74712 stores oneclip or more than two clips 74714. Each clip holder 74712 comprisesbiasing members 74713 (see FIG. 411 ) configured to bias the clips 74714away from the shaft axis SA. The clip track 74716 is configured toreceive a clip 74714 when one of the clips 74714 is biased into the cliptrack 74716 (e.g., when the clip magazine 74700 is in a loadingposition, for example). Further, when the clip magazine 74700 isinitially loaded into the clip applier one of the clips 74714 canalready be loaded in the clip track 74716 as illustrated in FIG. 406 .The clip magazine 74700 further comprises a lockout, or lockout clip74718, configured to prevent further rotation of the clip magazine 74700after all of the clips 74714 have been spent. The lockout clip 74718extends proximally further than the clips 74714, as illustrated in FIG.407 , to allow the lockout clip 74718 to interfere with the carriage74710 when the clip magazine 74700 is empty. Operation of the clipmagazine 74700 is described in greater detail below.

In the orientation depicted in FIG. 406 , the clip magazine 74700 is ina firing position. After initially loading the clip magazine 74700 intothe clip applier, a clip 74714 is already loaded into the clip track74716 by the biasing members 74713, as discussed above. The initiallyloaded clip 74714 can be advanced into the end effector of the clipapplier by a feeder shoe 74724 of the clip applier. The feeder shoe74724 extends on a side of the carriage 74710 to engage the clip 74714without interfering with the clip magazine 74700. Once the feeder shoe74724 is retracted, the next clip 74714 is rotated into place asdescribed in greater detail below.

Referring now to FIG. 408 , after the initial clip 74714 is advanced bythe feeder shoe 74724 and the feeder shoe 74724 is retracted, the clipmagazine 74700 is rotated toward a loading position (see FIG. 410 ). Asthe clip magazine 74700 rotates toward a loading position, the leadingedge of the next clip 74714 drops into a recessed portion 74719 of theclip track 74716 (see FIG. 408 ). As the clip magazine 74700 rotatesfurther toward the loading position, the clip 74714 begins to seat inthe clip track 74716 (see FIG. 409 ). Referring now to FIG. 410 , theclip 74714 is biased completely into the clip track 74716 by the biasingmembers 74713 when the clip 74714 and the clip track 74716 arecompletely aligned. The clip 74714 is now in the loading position.Further operation of the clip magazine 74700 is discussed in greaterdetail below.

As the clip magazine 74700 rotates from the loading position depicted inFIG. 410 to another firing position, the remaining clips 74714 are heldin their respective clip holders 74712. More specifically, referring toFIG. 410 , another clip 74714 is sitting on top of the clip 74714 in theclip track 74716 when the clip magazine 74700 is in the loading positon.This clip 74714 will continue to rotate with the carriage 74710 when thecarriage 74710 is rotated as there is no room for the clip 74714 to movetoward the clip track 74716 because the clip track 74716 is alreadyoccupied by a clip 74714. Once the clip magazine 74700 is rotated intothe firing position, the clip 74714 positioned in the clip track 74716is advanced into the end effector by the feeder shoe 74724, as discussedabove. As the clip magazine 74700 is rotated toward another loadingposition, another clip 74714 is stripped (i.e., biased into the cliptrack 74716), as discussed above. This sequence continues until all ofthe clips 74714 are stripped from the clip magazine 74700 and advancedinto the end effector. The outer clips 74714 (i.e., clips 2, 3, and 4)are stripped from the clip magazine 74700 first based on the arrangementdescribed above. Once all of the outer clips 74714 are stripped theinner clips 74714 (i.e., clips 5, 6, and the lockout clip 74718) can bestripped from the clip magazine 74700. The lockout clip 74718 of theclip magazine 74700 is described in greater detail below.

Referring now to FIG. 411 , after all of the clips 74714 have beenstripped from the clip magazine 74700, the lockout clip 74718 is biasedinto the clip track 74716 when the clip magazine 74700 is rotated into afinal loading position. As discussed above, the lockout clip 74718extends further proximally toward the carriage 74710 than the clips74714 (see FIG. 407 ). Therefore, when the lockout clip 74718 ispositioned in the clip track 74716 the lockout clip 74718 will interferewith the carriage 74710 as the clip magazine 74700 rotates from theloading position to the firing position. More specifically, the carriage74710 of the clip magazine 74700 will engage the top of the lockout clip74718 which prevents further rotation of the clip magazine 74700. Thebiasing members 74713 push the lockout clip 74718 into the clip track74716 and hold the lockout clip 74718 in place. Alternatively, thebiasing members 74713 in the last clip holder 74712 location can beconfigured to extend into the clip track 74716 to prevent furtherrotation of the clip magazine 74700 after all of the clips have beenspent.

As a means to minimize rotational binding of the clips 74714 as the clipmagazine 74700 rotates, the clip magazine 74700 can vary the amount offorce the biasing members 74713 apply to the clips 74714 depending onthe orientation of the clip magazine 74700, for example. In at least oneembodiment, the clip magazine 74700 can decrease the amount of force thebiasing members 74713 apply to the clips 74714 when the clip magazine74700 is in a firing position. Alternatively, the clip magazine 74700can increase the amount of force the biasing members 74713 apply to theclips 74714 in order to encourage the clip 74714 above the clip track74716 into the clip track 74716 when the clip magazine 74700 is in aloading position. Other embodiments are envisioned where the clipmagazine 74700 can relieve the spring bias of the biasing members 74713just before a clip 74714 is aligned with the clip track 74716 (see FIGS.408 and 409 ) and increase the spring bias when a clip 7471 is alignedwith the clip track 74716 (see FIG. 410 ) in order to only encourage theclip 74714 to eject from the clip holder 74712 when the clip 74714 andthe clip track 74716 are aligned. To reduce the spring bias in the nonloading positions (i.e. the firing positions), the inside diameter 74722of the clip magazine 74700 can be eccentric with respect to the travelpath of the carriage 74710. In such instances, the inside diameter 74722of the clip magazine 74700 can be shaped such that the biasing members74713 are compressed when the clip magazine 74700 is in a loadingposition providing more force to the clips 74714 Further, the insidediameter 74722 can provided room for the biasing members 74713 to extendwhen the clip magazine 74700 is in a firing position and/or moving froma firing position to a loading position to provide less force to theclips 74714.

Further to the above, as another means to minimize rotational binding ofthe clips 74714 as the clip magazine 74700 rotates, the inside diameter74722 of the clip magazine 74700 can be polished to reduce the frictionbetween the carriage 74710 and the inside diameter 74722. Otherembodiments are envisioned where the inside diameter 74722 is onlypolished in certain areas to reduce rotational friction when thecarriage 74710 is rotated through certain radial positions, for example.In such instances, the high friction forces can hold the clip magazine74700 in position when firing.

FIGS. 412-416 depict a clip applier 74800 in accordance with at leastone embodiment. The clip applier 74800 comprises a clip magazine 74810comprising a plurality of clips, a rotary input 74820, a shaft 74830extending from a housing, a feeder shoe 74840, and a crimping drive74850. The shaft 74830 defines a shaft axis SA and the clip magazine74810 is translatable along and rotatable about the shaft axis SA. Theplurality of clips comprise a first set of clips 74806 stored on a firstside 74812 of the clip magazine 74810, a second set of clips 74807stored on a second side 74814 of the clip magazine 74810, and a thirdset of clips 74808 stored on a third side 74816 of the clip magazine74810. The first side 74812, the second side 74814, and the third side74816 are positioned approximately 120 degrees apart about the shaftaxis SA. Each of the first, second, and third sets of clips 74806,74807, 74808 are biased radially outward relative to the clip magazine74810 by biasing members 74809 (see FIG. 414 ). The first, second, andthird sets of clips 74806, 74807, 74808 are stored in clip slots 74804of the clip magazine 74810. The rotary input 74820 is configured torotate in response to rotary motions generated by a motor positioned inthe housing of the clip applier 74800. The rotary input 74820 isthreadably engaged with the clip magazine 74810. Operation of the clipapplier 74800 is discussed in greater detail below.

To strip the first set of clips 74806 from the clip magazine 74810, theclip magazine 74810 is translated distally by the rotary input 74820until the first set of clips 74806 are aligned with a loading slot 74832in the bottom of the shaft 74830 of the clip applier 74800. The firstset of clips 74806 comprises a first clip 74806 a and a second clip74806 b (see FIG. 416 ). The clip magazine 74810 is rotatablyconstrained within the shaft 74830 of the clip applier 74800 by thefirst set of clips 74806 and the biasing members 74809 such that whenthe rotary input 74820 is rotated in direction D1, the clip magazine74810 is translated between a proximal position (FIG. 412 ) and a distalposition (FIG. 413 ).

The clip magazine 74810 can then be retracted from the distal position(FIG. 413 ) to the proximal position (FIG. 412 ) to strip the first clip74806 a from the clip magazine 74810 by rotating the rotary input 74820is an opposite direction D2. Notably, the second clip 74806 b of thefirst set of clips 74806 is positioned on top of the first clip 74806 ain the loading slot 74832 when the clip magazine 74810 is in the distalposition, and therefore, the clip magazine 74810 is still rotatablyconstrained via the biasing members 74809. Thus, the clip magazine 74810will translate proximally in response to a rotation of the rotary input74820 in direction D2 (FIG. 412 ). Once the clip magazine 74810 isretracted to the proximal positon, the first clip 74806 a in the loadingslot 74832 can be advanced into an end effector of the clip applier74800 by the feeder shoe 74840. The clip magazine 74810 can then betranslated from the proximal position to the distal position to placethe second clip 74806 b into the loading slot 74832. At this point, theclip magazine 74810 is still rotatably constrained by the biasingmembers 74809 which are still engaged with the second clip 74806 b as itsits in the loading slot 74832. As such, rotation of the rotary input74820 will translate the clip magazine 74810 proximally when the rotaryinput 74820 is rotated in the second direction D2. Further, when thebiasing members 74809 are retracted proximally beyond the loading slot74832, the biasing members 74809 still apply a force to the shaft 74830of the clip applier 74800 and thus continue to rotatably constrain theclip magazine 74810. Once the clip magazine 74810 is in the proximalposition, the second clip 74860 b in the loading slot 74832 can beadvanced into the end effector of the clip applier 74800 by the feedershoe 74840. At this point, the clip magazine 74810 no longer has clipsremaining on the first side 74812 of the clip magazine 74810. The clipmagazine 74810 can then be translated from the proximal position (FIG.412 ) to the distal position (FIG. 413 ) owing to the biasing members74809 rotatably constraining the clip magazine 74810 against the shaft74830, as discussed above. Once in the distal position (FIG. 413 ), theclip magazine 74810 will no longer be rotatably constrained as thebiasing members 74809 no longer have a clip in the loading slot 74832 topress against; and, thus, the biasing members 74809 no longer rotatablyconstrain the clip magazine 74810. More specifically, the biasingmembers 74809 only extend downward far enough to engage the shaft 74830of the clip applier 74800 and do not extend into the loading slot 74832.Thus, if a clip is not positioned in the loading slot 74832, the clipmagazine 74810 will rotate in response to the rotation of the rotaryinput 74820. At this point, rotation of the rotary input 74820 rotatesthe clip magazine 74810.

Further to the above, when the loading slot 74832 is empty and therotary input 74820 is rotated, the clip magazine 74810 will rotate untilthe second set of clips 74807 align with, and are biased toward, theloading slot 74832. The first clip of the second set of clips 74807 willoccupy the loading slot 74832 and thus the clip magazine 74810 willagain be rotatably constrained as discussed above. The clip magazine74810 can now be translated between the distal position (FIG. 413 ) andthe proximal position (FIG. 412 ) to strip the first clip and the secondclip of the second set of clips 74807 from the clip magazine 74810. Oncethe first and second clip of the second set of clips 74807 are strippedand advanced, the clip magazine 74810 can be rotated to align the thirdset of clips 74808 with the loading slot 74832. The third set of clips74808 can follow the same ejection and advancement sequence as the firstset of clips 74806 and the second set of clips 74807. Other embodimentsare envisioned where the clip magazine 74810 comprises more or less thanthree sides comprising clips, for example.

As the clip magazine 74810 translates from the proximal position (seeFIG. 412 ) to the distal position (see FIG. 413 ), further to the above,the clip magazine 74810 engages a distal stop 74860 which extendsdownward from the shaft 74830 of the clip applier 74800. The distal stop74860 prevents further distal translation of the clip magazine 74810 andproperly aligns the clip magazine 74810 with the loading slot 74832.Further, the rotary input 74820 comprises a proximal stop 74862 whichprevents further proximal translation of the clip magazine 74810. Asmentioned above, the rotary input 74820 is threadably engaged with theclip magazine 74810. Other embodiments are envisioned with differentrotary input to clip magazine connections, as discussed in greaterdetail below.

FIG. 417 depicts a rotary input 74920 and a clip magazine 74910 inaccordance with at least one embodiment. The rotary input 74920 and clipmagazine 74910 are similar to the rotary input 74820 and clip magazine74810 of the clip applier 74800 in many respects (see FIGS. 412-416 ).For example, the rotary input 74920 is threadably engaged with the clipmagazine 74910 and the rotary input 74820 is configured to advance,retract, and rotate the clip magazine 74910. The rotary input 74920comprises protrusions 74922 extending from a distal end of the rotaryinput 74920. The protrusions 74922 are engaged with an internal thread74912 of the clip magazine 74910. When the rotary input 74920 isrotated, and the clip magazine 74910 is rotatably constrained, the clipmagazine 74910 will translate. In such instances, the protrusions 74922of the rotary input 74920 engage the internal threads 74912 of the clipmagazine 74910 to linearly advance and retract the clip magazine 74910.The rotary input 74920 is configured to rotate in a first direction totranslate the clip magazine 74910 distally and, correspondingly, asecond direction, opposite the first direction, to translate the clipmagazine 74910 proximally. In use, the rotary input 74920 is rotatedclock-wise and counter clock-wise to achieve the desired range of motionfor the clip magazine 74910, such as translating the clip magazine 74910back and forth between a proximal position and a distal position, forexample.

FIGS. 418 and 419 depict a rotary input 74940 and a clip magazine 74930in accordance with at least one embodiment. The rotary input 74940 andclip magazine 74930 are similar to the rotary input 74820 and clipmagazine 74810 of the clip applier 74800 in many respects (see FIGS.412-416 ). For example, the rotary input 74940 is threadably engagedwith the clip magazine 74930 and the rotary input 74940 is configured toadvance, retract, and rotate the clip magazine 74930. The clip magazine74930 comprises a plurality of clips 74934 and a biasing member 74936which acts to bias the clips 74934 out of the clip magazine 74930. Therotary input 74940 comprises external threads 74942 which are engagedwith a collar 74932 in the clip magazine 74930. The collar 74932 engagesthe external threads 74942 at the base of the external threads 74942 andis configured to ride along the external threads 74942 of the rotaryinput 74940 to translate the clip magazine 74930 when the rotary input74940 is rotated. The rotary input 74940 is a multi-direction rotarydriver for the clip magazine 74930 that advances and retracts the clipmagazine 74930 to strip clips from the clip magazine 74930. The rotaryinput 74940 is configured to rotate in a first direction to advance theclip magazine 74930 distally and, correspondingly, in a seconddirection, opposite the first direction, to advance the clip magazine74930 proximally. In use, the rotary input 74940 is rotated clock-wiseand counter clock-wise to achieve the desired range of motion for theclip magazine 74930, such as translating the clip magazine 74930 backand forth between a proximal position and a distal position, forexample.

FIG. 420 depicts a rotary input 74960 and a clip magazine 74950 inaccordance with at least one embodiment. The rotary input 74960 and clipmagazine 74950 are similar to the rotary input 74820 and clip magazine74810 of the clip applier 74800 in many respects (see FIGS. 412-416 ).For example, the rotary input 74960 is threadably engaged with the clipmagazine 74950 and is configured to advance, retract, and rotate theclip magazine 74950. The rotary input 74960 comprises protrusions 74962extending from the rotary input. The protrusions 74962 are engaged withan internal thread 74952 of the clip magazine 74950. The internal thread74952 is a single-direction thread; thus, when the rotary input 74960 isrotated and the clip magazine 74950 is rotatably constrained, the clipmagazine 74950 translates between a proximal position and a distalposition. Once the clip magazine 74950 has reached the distal position,the protrusions 74962 move through a distal end 74954 of the internalthread 74952 which switches the direction the clip magazine 74950 istranslated while the rotary input 74960 rotates in the same direction.The internal thread 74952 comprises a left-hand thread portion and aright-hand thread portion which are connected at their distal ends suchthat the left-hand threaded portion and the right-hand threaded portioncomprise one continuous thread groove. Therefore, the rotary input 74960need only be rotated in one direction to achieve the desired range ofmotion for the clip magazine 74950, i.e., translating the clip magazine74950 back and forth between the proximal position and the distalposition.

FIG. 421 depicts a rotary input 74980 and a clip magazine 74970 inaccordance with at least one embodiment. The rotary input 74980 and clipmagazine 74970 are similar to the rotary input 74820 and clip magazine74810 in many respects. For example, the rotary input 74980 isthreadably engaged with the clip magazine 74970 and the rotary input74880 is configured to advance, retract, and rotate the clip magazine74970. The rotary input 74980 comprises a thread groove 74982 defined onthe outside of the rotary input 74980 which is engaged with a collar74972 in the clip magazine 74970. The collar 74972 engages the threadgroove 74982 at the base of the thread groove 74982. The thread groove74982 is a single-direction thread, thus, when the rotary input 74980 isrotated and the clip magazine 74970 is rotatably constrained, the clipmagazine 74970 translates back and forth between a proximal position anda distal position. Once the clip magazine 74970 has reached the distalposition, the collar 74972 will move through a distal end 74984 of thethread groove 74982 which switches the direction the clip magazine 74970is translated while the rotary input 74980 rotates in the samedirection. The thread groove 74982 comprises a left-hand thread portionand a right-hand thread portion which are connected at their distal endssuch that the left-hand threaded portion and the right-hand threadedportion comprise one continuous thread groove. Therefore, the rotaryinput 74980 need only be rotated in one direction to achieve the desiredrange of motion for the clip magazine 74970, i.e., translating the clipmagazine 74970 back and forth between the proximal position and thedistal position.

FIG. 422 depicts a rotary input 74990 and a clip magazine 74995 inaccordance with at least one embodiment. The rotary input 74990 and theclip magazine 74995 are similar to the rotary input 74820 and clipmagazine 74810 of the clip applier 74800 in many respects (see FIGS.412-416 ). For example, the rotary input 74990 is threadably engagedwith the clip magazine 74995 and the rotary input 74980 and the clipmagazine 74995 are configured to advance, retract, and rotate the clipmagazine 74995. The clip magazine 74995 comprises an upper portion 74995a and a lower portion 74995 b which are assembled together usingalignment pins 74999 and a coupling collar 74997. The clip magazine74995 further comprises a cutout region 74996 configured to receive thecoupling collar 74997 when the upper portion 74995 a and the lowerportion 74995 b are positioned together. The coupling collar 74997 andalignment pins 74999 are configured to hold the upper portion 74995 aand the lower portion 74995 b together.

Further to the above, the clip magazine 74995 comprises an internalthread 74991 that can be molded and/or machined into the inside diameterof the clip magazine 74995. The upper portion 74995 a and the lowerportion 74995 b can be assembled around the rotary input 74990 such thatprotrusions 74992 extending from the rotary input 74990 are engaged withthe internal thread 74991. The internal threads 74991 can be moldedand/or machined into any of the internal threads types described herein.The rotary input 74990 can be a single direction driver and/or a multidirection driver, as described herein, depending on the internal threadsutilized. Further, a crimping drive 74993 can be placed through anopening in the rotary input 74990 such that the crimping drive 74993 andthe rotary input 74990 are co-axial. The crimping drive 74993 isconfigured to actuate jaws of an end effector of the clip applier tocrimp a clip positioned between the jaws.

A cross-sectional view of the clip magazine 74995 located inside a shaft74994 of a clip applier, for example, is depicted in FIG. 423 . In orderto achieve the clam-shell construction described above (e.g., piecingtogether the upper portion 74995 a and the lower portion 74995 b of theclip magazine 74995) the clip magazine 74995 can be split so that onlyone clip storage location 74998 is cut in half. This allows for easyassembly and alignment of the upper portion 74995 a and the lowerportion 74995 b.

FIG. 424 depicts a clip applier 76000 in accordance with at least oneembodiment. The clip applier 76000 comprises a rotary input 76022, amagazine driver 76020 extending from the rotary input 76022, a clipmagazine 76010, a firing drive 76030, and a biasing member 76040. Therotary input 76022 comprises a flexible rotary drive to flex and/or bendaround an articulation joint of the clip applier. The magazine driver76020 comprises a first cam surface 76024 comprising a notch 76026 atthe distal end thereof. The clip magazine 76010 comprises a second camsurface 76014 comprising a protrusion 76016 extending from the proximalend thereof. The clip applier 76000 is shown in an exploded view in FIG.424 , with the clip magazine 76010 separated from the magazine driver76020 in order to show the biasing member 76040.

Further to the above, the clip magazine 76010 is configured to translatebetween a proximal position (FIG. 425 ) and distal position (FIG. 426 )relative to the magazine driver 76020 as the magazine driver 76020rotates. The biasing member 76040 is configured to bias the clipmagazine 76010 toward the proximal position and against the magazinedriver 76020. The first cam surface 76024 and the second cam surface76014 comprise complementary shapes and, when the clip magazine 76010 isin the proximal position (FIG. 425 ), the first cam surface 76024 andthe second cam surface 76014 are aligned. The second cam surface 76014comprises a raised shoulder and the first cam surface 76024 is supportedby a body 76003 of the clip magazine 76010 when the clip magazine 76010and magazine driver 76020 are engaged. The clip magazine 76010 furthercomprises a first clip storage location 76001, a second clip storagelocation 76002, and a third clip storage location configured to storeclips 76004 for clipping tissue. In the embodiment illustrated in FIG.424 , there are three clip storage locations, each of the clip storagelocations are configured to store two clips 76004. Other embodiments areenvisioned with more than or less than three clip storage locations witheach clip storage location storing more or less than two clips 76004,for example. The rotary input 76022 is configured to rotate the magazinedriver 76020 to both translate and rotate the clip magazine 76010 asdescribed in greater detail below.

Referring now to FIG. 425 , the clip magazine 76010 is in its proximalposition relative to the magazine driver 76020. As the rotary input76022 is rotated in a first direction D₁, the first cam surface 76024 ofthe magazine driver 76020 engages the second cam surface 76014 of theclip magazine 76010 to translate the clip magazine 76010 to its distalposition (FIG. 426 ). In the distal position, the first clip storagelocation 76001 is located over a loading slot of the clip applier,similar to loading slot 74832 described in relation to clip applier74800, for example. In at least one embodiment, a clip 76004 is ejectedout of the first clip storage location 76001 by the biasing members76006 into the loading slot when the first clip storage location 76001is aligned with the loading slot. The rotary input 76022 is then rotatedin a second direction D₂ to move the magazine driver 76020 from thedistal position to the proximal position to strip the clip 76004 fromthe clip magazine 76010. Notably, the biasing member 76040 pulls theclip magazine 76010 toward the magazine driver 76020 such that thesecond cam surface 76014 and the first cam surface 76024 are continuallyengaged as the magazine driver 76020 is rotated in the second directionD₂. After the first clip in the first clip storage location 76001 hasbeen stripped, the clip magazine 76010 can be advanced from the proximalposition to the distal position, as discussed above, to align the secondclip in the first clip storage location 76001 with the loading slot. Tostrip the second clip, the clip magazine 76010 is rotated to align thesecond clip storage location 76002 with the loading slot as discussed ingreater detail below.

With the second clip of the first clip storage location 76001 located inthe loading slot and the clip magazine 76010 positioned in its distalposition, a further rotation of the magazine driver 76020 in the firstdirection D₁ will rotate the clip magazine 76010 to strip the secondclip from the first clip storage location 76001. In such instances, therotary input 76022 will rotate the magazine driver 76020 to engage thenotch 76026 of the magazine driver 76020 with the protrusion 76016 ofthe clip magazine 76010. Once the notch 76026 and the protrusion 76016are engaged, the clip magazine 76010 will rotate with the magazinedriver 76020 as the rotary input 76022 rotates in direction D₁. The clipmagazine 76010 rotates 120 degrees in the first direction D₁ to alignthe second clip storage location 76002 with the loading slot asillustrated in FIG. 427 . The first clip 76004 in the second clipstorage location 76002 is stripped from the clip magazine 76010 bytranslating the clip magazine 76010 from its distal position to itsproximal position via the magazine driver 76020 and biasing member76040, as discussed above. After the first clip 76004 in the second clipstorage location 76002 has been stripped, the clip magazine 76010 can berotated by the magazine driver 76020 another 120 degrees in the firstdirection D₁ to strip the second clip in the second clip storagelocation 76002 and align the third clip storage location with theloading slot. The first clip in the third clip storage location can bestripped via the retraction of the clip magazine 76010 between itsdistal position and its proximal position, as discussed above. Thesecond clip in the third clip storage location can also be stripped viathe retraction of the clip magazine 76010 between its distal positionand its proximal position, as discussed above. Further, the second clipin the third clip storage location can also be stripped via a rotationof the clip magazine 76010 in the first direction D₁ when the clipmagazine is in its distal position, as discussed above.

Further to the above, alternative embodiments are envisioned where theclip magazine 76010 comprises a notch at the proximal end of the secondcam surface 76014 and the magazine driver 76020 comprises a protrusionat the distal end of the first cam surface 76024. The notch andprotrusion can perform the same functions as the notch 76026 andprotrusion 76016 discussed above (i.e., engaging the magazine driver76020 with the clip magazine 76010 in its distal position to rotate theclip magazine 76010, for example).

FIG. 428 is a graphical depiction of the rotary position of the magazinedriver 76020 of the clip applier 76000 versus time. When the magazinedriver 76020 is at position 76110, the clip magazine 76010 is in itsproximal position illustrated in FIG. 425 . When the magazine driver76020 is rotated to 90 degrees from zero, the clip magazine 76010 ismoved to its distal position depicted in FIG. 426 and the first clip76004 from the first clip storage location 76001 is biased into theloading slot. The magazine driver 76020 can then be rotated back to 0degrees at position 76120 to strip the first clip 76004 from the firstclip storage location 76001, as discussed above. The magazine driver76020 can then be rotated 90 degrees from zero to place the second clipfrom the first clip storage location 76001 into the loading slot atposition 76130. The second clip from the first clip storage location76001 is then stripped when the magazine driver 76020 is rotated to 210degrees from zero at position 76140. The second clip storage location76002 is now aligned with the loading slot, and the first clip from thesecond clip storage location 76002 is biased into the loading slot atposition 76140. The first clip from the second clip storage location76002 is stripped when the magazine driver 76020 is rotated back to 90degrees from zero at position 76150. As the magazine driver 76020rotates to 210 degrees from zero the second clip from the second clipstorage location 76002 is aligned with, and biased into, the loadingslot at position 76160. The magazine driver is then rotated to 330degrees from zero to strip the second clip from the second clip storagelocation 76002 and to align the first clip from the third clip storagelocation with the loading slot at position 76170. The first clip fromthe third clip storage location can be stripped when the magazine driver76020 rotates back to 210 degrees from zero at position 76180. Thesecond clip in the third clip storage location is then aligned with, andbiased into, the loading slot when the magazine driver 76020 is rotatedto 330 degrees from zero. The second clip in the third clip storagelocation can be stripped from the clip magazine 70610 either by rotatingmagazine driver 76020 back 90 degrees to 210 degrees from zero atposition 76194 to retract the clip magazine 70610 to the proximalposition, or by rotating the magazine driver 76020 an additional 120degrees to 90 degrees from zero at position 76192 to rotate the clipmagazine 70610 and strip the clip.

FIG. 429 depicts a clip applier 76200 in accordance with at least oneembodiment. The clip applier 76200 comprises a distal head 76220extending from an elongate shaft, a clip magazine 76210, an end effector76230 extending through and from the distal head 76220, a clip carriage76260, and a clip former 76242. The distal head 76220 is articulatablerelative to the elongate shaft. The end effector 76230 comprises a pairof opposing jaws which are movable between an open position and closedposition by a jaw cam 76232, as discussed herein. The jaw cam 76232 isoperably engaged with a jaw cam driver 76250. As the jaw cam driver76250 is rotated, the jaw cam 76232 is translated between a proximalposition and a distal position to move the jaws of the end effector72630 between the open position and the closed position. The jaw camdriver 76250 is rotatable in response to rotary motions generated by amotor in the housing of the clip applier 76200.

Further to the above, the jaw cam driver 76250 passes through an openingin the clip magazine 76210 and through an opening in a magazine driver76202 extending proximally from the clip magazine 76210. The magazinedriver 76202 is configured to rotate the clip magazine 76210 in responseto rotary motions generated by the motor in the housing of the clipapplier 76200. The magazine driver 76202 and the jaw cam driver 76250are configured to rotate about the same axis (see FIG. 438 ). The clipmagazine 76210 comprises a plurality of clips 76204 stored in aplurality of clip storage locations. Each clip storage locationcomprises a pair of clips 76204 stacked on top of one another, forexample. The clips 76204 can be biased out of the clip storage locationsby a biasing member, such as a leaf spring, for example, into a loadingslot 76262 of the clip carriage 76260 as described in further detailbelow. Other embodiments are envisioned where the clip magazine 76210stores one clip or more than two clips 76204 in each clip storagelocation.

The clip magazine 76210 is configured to rotate between a plurality ofstorage positions and a plurality of ejection positions. In the storagepositions of the clip magazine 76210, the clips 76204 cannot be ejectedfrom the clip magazine 76010. In the ejection positions of the clipmagazine 76210, one of the clip storage locations is aligned with theloading slot 76262 of the clip carriage 76260, and one of the clips76204 is biased from the clip magazine 76210 into the loading slot76262. After a clip 76204 is positioned in the loading slot 76262, asillustrated in FIG. 430 , the clip 76204 can either be advanced distallyto a staging position 76224 or retracted proximally to a forming positon76228 by the clip carriage 76260 as described in greater detail below.

The clip carriage 76260 is configured to translate proximally anddistally in response to the rotation of a carriage driver 76264. Thecarriage driver 76264 is configured to rotate in response to rotarymotions generated by the motor in the housing of the clip applier 76200.To advance a clip 76204 into the staging position 76224, the carriagedriver 76264 is rotated in a first direction. After the clip carriage76260 advances the clip 76204 to the staging position 76224 (see FIG.431 ), the clip carriage 76260 can be retracted proximally as a biasingmember, or leaf spring 76226, engages the back side of the clip 76204 tokeep the clip 76204 in the staging position 76224 (see FIG. 432 ). Theclip carriage 76260 is retracted via the carriage driver 76264 as thecarriage driver 76264 rotates in a second direction opposite the firstdirection. After the clip 76204 is placed in the staging position 76224and the clip carriage 76260 is retracted, the clip carriage 76260 can beadvanced to engage a distal end 76266 of the clip carriage 72260 withthe clip 76204 to advance the clip 76204 into the end effector (seeFIGS. 432 and 433 ).

Further to the above, after a clip 76204 is positioned in the loadingslot 76262 from the clip magazine 76210, as illustrated in FIG. 430 ,the clip carriage 76260 is retracted to a forming positon 76228 byrotating the carriage driver 76264 in the second direction. Once in theforming positon 76228 (see FIGS. 434 and 435 ), the clip former or,anvil 76242, is lowered in between opposing legs 76204 a and 76204 b(see FIGS. 436 and 437 ) of the clip 76204 by an anvil driver 76240. Theanvil driver 76240 is configured to translate in response to rotarymotions generated by the motor of the clip applier 76200, or anothermotor of the clip applier 76200, such that, as the anvil driver 76240 istranslated, the anvil 76242 is configured to translate closer to andaway from the loading slot 76262 of the clip carriage 76260—depending onthe direction of translation of the anvil driver 76240.

Notably, the anvil driver 76240 comprises a pair of laterally extendingpins 76244 which engage a pair of angled slots 76246 in the anvil 76242.When the anvil driver 76240 is translated distally, the anvil movestoward the loading slot 76262. When the anvil driver 76240 is translatedproximally, the anvil 76242 moves away from the loading slot 76262.Forming of the clip 76204 positioned in the loading slot 76262 isdescribed in further detail below.

After the anvil 76242 is lowered in between the legs 76204 a and 76204 bof the clip 76204, the clip carriage 76260 is advanced distally, asdiscussed above, such that the legs 76204 a and 76204 b of the clip76204 are expanded away from each other by the anvil 76242 (see FIG. 437). The clip 76204 comprises an angled portion 76206 connecting the legs76204 a and 76204 b of the clip 76204 which is engaged by the anvil76242 as the clip carriage 76260 is advanced such that the angledportion 76206 is deformed from a collapsed orientation (see FIG. 436 )to an expanded orientation (see FIG. 437 ). After the clip 76204 hasbeen expanded, the anvil 76242 can be moved away from the loading slot76262 by the anvil driver 76240 such that the clip carriage 76260 canadvance the clip 76204 into the staging position 76224, as describedabove. Once in the staging position 76224, the clip 76204 can beadvanced into the end effector 76230 as discussed above.

Further to the above, the staging position 76224 is configured to storea single clip 76204. However, other embodiments are envisioned where thestaging position 76224 is configured to store a plurality of clips 76204in a clip stack, for example. The plurality of clips in the clip stackin the staging position 76224 can either be formed or unformed, asdiscussed above, and can be stacked in the staging position 76224 untilthey are sequentially advanced into the end effector by the clipcarriage 76260 in the manner discussed above.

As discussed above, the jaw cam driver 76250, the magazine driver 76202,the carriage driver 76264, and the anvil driver 76240 are configured torotate in response to rotary motions generated by the same motor of theclip applier 76200, or different motors of the clip applier 76200, inorder to perform specific distal head functions. The motor of the clipapplier 76200 further comprises a motor controller configured to controlthe jaw cam driver 76250, the magazine driver 76202, the carriage driver76264, and the anvil driver 76240. The jaw cam driver 76250, themagazine driver 76202, the carriage driver 76264, and the anvil driver76240 can be actuated by the motor controller to synchronize the driversand/or interrupt one or more of the drivers in order to perform moredistal head functions than there are dedicated drivers.

FIG. 439 depicts a clip applier 76300 in accordance with at least oneembodiment. The clip applier 76300 comprises an outer tube 76305extending from a housing, a clip magazine 76307 attachable to the outertube 76305, and an end effector 76309. The outer tube 76305 comprises aproximal tube portion 76380, an articulation tube portion 76350extending from the proximal tube portion 76380, and a distal tubeportion 76340 extending from the articulation tube portion 76350. Theend effector 76309 comprises a first jaw 76310 movable relative to asecond jaw 76320 between an open positon and a closed position. Thesecond jaw 76320 extends from the distal tube portion 73640 and thefirst jaw 76310 is rotatable relative to the second jaw about a pivotpin 76315. The first jaw 76310 is actuatable between the open positionand the closed position via a jaw driver 76360 which is configured torotate relative to the outer tube 76305 in response to rotary motionsgenerated within the housing of the clip applier 76300. Otherembodiments are envisioned where the first jaw 76310 and the second jaw76320 are both rotatable relative to each other between an open and aclosed position, for example.

Further to the above, the clip magazine 76307 comprises a plurality ofclips removable stored therein. Each of the clips is translatable intothe end effector 76309 by a clip advancer of the clip applier 76300which is operably responsive to a clip driver 76370. The clip driver76370 is configured to rotate relative to the outer tube 76305 inresponse to rotary motions generated by the motor within the housing ofthe clip applier 76300. The clip driver 76370 is housed within anopening in the jaw driver 76360 such that the clip driver 76370 and thejaw driver 76360 are co-axial. In other words, the clip driver 76370 andjaw driver 76360 comprise a nested rotary drive train. Further, both theclip driver 76370 and the jaw driver 76360 are operable independently ofone another via the motor of the clip applier 76300. The articulationtube portion 76350, the jaw driver 76360, and the clip driver 76370 areconfigured to bend and/or flex as the outer tube 76305 is articulated.The jaw driver 76360 and the clip driver 76370 may be comprised of dualwoven cables which provide torsional force no matter the direction thejaw driver 76360 and clip driver 76370 are rotated, for example. Invarious instances, the jaw driver 76360 and the clip driver 76370 mayprovide equal torsional force no matter the direction they are rotated,for example.

FIG. 440 depicts a clip applier 76300′ in accordance with at least oneembodiment. The clip applier 76300′ is similar in many respects to theclip applier 76300. For example, the clip applier 76300′ comprises a jawdriver 76360′ and a clip driver 76370′ which perform the same endeffector functions as the jaw driver 76360′ and the clip driver 76370′,respectively. However, the jaw driver 76360′ and the clip driver 76370′may be comprised of wire tubing which provides a different torsionalforce depending on the direction the jaw driver 76360′ and the clipdriver 76370′ are rotated, for example. Other embodiments are envisionedwhere the jaw drivers 76360 and 76360′ and/or the clip drivers 76370 and76370′ are comprised of dual woven cables and/or wire tubing andcombinations thereof. In other words, construction of the tubes orshafts (e.g., the jaw drivers 76360, 76360′ or the clip drivers 76370,76370′) could be selected based on the amount of torque required toperform a specific end effector function such as feeding a clip orcrimping a clip, for example. Notably, dual woven cables may be morecompatible with higher loads in both directions, and wire tubing (i.e.,wound springs, for example) may be better suited to transmit torsionalloads in one direction better than another. More specifically, wiretubing is wound in a specific direction; thus, less force is required torotate the wire tubing in the direction of the windings as compared torotating the wire tubing in the direction opposite the windings.Further, dual woven cables may comprise windings woven together inopposite directions; thus, it will require the same amount of force torotate the dual woven cable in either direction if the windings arebalanced, for example.

FIG. 441 depicts a rotary input 76400 in accordance with at least oneembodiment. The rotary input 76400 may be utilized to drive distal headfunctions of any of the clip appliers discussed herein. The rotary input76400 comprises an outer hollow tube 76410 and an inner hollow tube76420 which rotate together. The inner hollow tube 76420 is housedinside the outer hollow tube 76410. The outer hollow tube 76410comprises a plurality of coiled springs 76412 wound in a firstdirection. The inner hollow tube 76420 comprises a plurality of coiledsprings 76422 wound in a second direction opposite the first direction.The plurality of coiled springs 76412 are interlocked with the pluralityof coiled springs 76422. More specifically, each of the coiled springs76422 in the inner hollow tube 76420 are flanked by a pair of coiledsprings 76412 of the outer hollow tube 76410 such that each of thecoiled springs in the inner hollow tube 76420 are intermediate the pairof coiled springs 76412 of the outer hollow tube 76410 such that torqueis transmitted therebetween.

In at least one alternative embodiment, a clip applier may comprise arotary input comprising solid wall tubes that are laser cut to create aninterlocking pattern. The interlocking pattern provides a preferredrotational direction for the rotary input. Further, such a rotary inputis relatively flexible to facilitate articulation of the end effectorabout an articulation joint as described in further detail in U.S.patent application Ser. No. 13/536, 232, filed on Jun. 28, 2012, whichis incorporated by reference in its entirety.

FIG. 442 depicts a clip applier 77000 in accordance with at least oneembodiment. The clip applier 77000 comprises a shaft 77010 extendingfrom a housing, an end effector 77050 (see FIG. 458 ) extending from theshaft 77010, a clip magazine 77020, and a clip advancer 77030. The clipmagazine 77020 and the clip advancer 77030 are housed within the shaft77010. The clip magazine 77020 is configured to translate and rotaterelative to the shaft 77010 in response to a translating motiontransmitted from the housing. The clip advancer 77030 is configured totranslate relative to the shaft 77010 when the clip magazine 77020 istranslated as the clip advancer 77030 is translatably coupled to theclip magazine 77020. The clip magazine 77020 is configured to store aplurality of clips 77004 in a plurality of clip slots 77022 positionedradially around the clip magazine 77020. Each clip slot 77022 comprisesa clip spring 77025 configured to bias a clip 77004 out of the clipmagazine 77020.

The clip advancer 77030 comprises a slot 77036, a proximal feeder spring77032, and a distal feeder spring 77034. As discussed below, theproximal feeder spring 77032 and the distal feeder spring 77034 advanceand hold clips in position as the clips are advanced into the endeffector 77050. The shaft 77010 comprises a stationary spring 77018extending into a loading slot 77015 of the shaft 77010. The loading slot77015 is configured to temporarily store a clip 77004 before the clip isadvanced into the end effector 77050 of the clip applier 77000. Theshaft 77010 comprises a groove 77012 comprising a translation portion77014 and a rotation portion 77016. The clip magazine 77020 comprisespins 77024 configured to ride within the groove 77012 in order totranslate and rotate the clip magazine 77020, as described in greaterdetail below.

When the clip magazine 77020 is in a proximal position, referring againto FIG. 442 , the pins 77024 of the clip magazine 77020 are located in aproximal portion of the translation portion 77014 of the groove 77012.As the clip magazine 77020 is translated distally to a distal position,as illustrated in FIG. 443 , the clip magazine 77020 and the clipadvancer 77030 translate together distally and the pins 77024 ridewithin the translation portion 77014 of the groove 77012. As the clipmagazine 77020 translates to the distal position (FIG. 443 ), the clipslot 77022 of the clip magazine 77020 will align with the loading slot77015 of the shaft 77010 and the clip spring 77025 will bias the clip77004 into the loading slot 77015, as illustrated in FIG. 443 . When theclip magazine 77020 is retracted from the distal position toward theproximal position, as illustrated in FIG. 444 , the pins 77024 of theclip magazine 77020 are configured to ride within the rotation portion77016 of the groove 77012 to rotate the clip magazine 77020 relative tothe shaft 77010 and retract the clip magazine 77020 to the proximalposition. As the clip magazine 77020 rotates and translates proximally,the clip 77004 in the loading slot 77015 is left behind in the loadingslot 77015, as illustrated in FIG. 445 . At such point, the clip 77004can be advanced into the end effector 77050.

As the clip magazine 77020 and the clip advancer 77030 are translateddistally from the proximal position to the distal position, the proximalfeeder spring 77032 will engage the clip 77004 in the loading slot 77015and translate the clip 77004 distally into a staging position 77017within the shaft 77010 of the clip applier 77000, as illustrated inFIGS. 446-448 . As the proximal feeder spring 77032 pushes the clip77004 distally, referring to FIG. 449 , the clip 77004 engages thestationary spring 77018 which biases the clip 77004 from the loadingslot 77015 into the staging position 77017. As the clip advancer 77030and the clip magazine 77020 are retracted, the clip 77004 will remain inthe staging position 77017, as illustrated in FIG. 450 . The stagingposition 77017 comprises a slot, or any suitable means of holding theclip 77004.

Referring now to FIGS. 451-453 , after the clip 77004 is positioned inthe staging position 77017, the clip magazine 77020 can be translatedagain to the distal position to advance the clip 77004 into a clip track77052 (see FIG. 458 ). More specifically, as the clip magazine 77020 ismoved toward the distal position, the distal feeder spring 77034 of theclip advancer 77030 will engage the clip 77004 and advance the clip77004 from the staging position 77017 (see FIG. 451 ) into the cliptrack 77052 (see FIG. 453 ).

As discussed above, the clip magazine 77020 is configured to hold aplurality of clips 77004. However, only one clip 77004 is shown in FIGS.442-453 in order to show how the clip 77004 is advanced by the clipadvancer 77030 and clip magazine 77020. Referring primarily to FIG. 454, with each retraction of the clip magazine 77020 from the distalposition to the proximal position the clip magazine 77020 will rotate,as discussed above. Thus, when the clip 77004 is advanced into theloading slot 77015 and the clip advancer 77030 and clip magazine 77020are retracted, the clip magazine 77020 will rotate relative to the clipadvancer 77030 to align a second clip 77005 with the slot 77036 of theclip advancer 77030. Thereafter, the second clip 77005 is advanced bythe clip advancer 77030 into the loading slot 77015 while the clip 77004is advanced by the proximal feeder spring 77032 into the stagingposition 77017, as discussed above. The clip advancer 77030 and clipmagazine 77020 can then be retracted again while leaving the clip 77004in the staging position 77017 and leaving the second clip 77005 in theloading slot 77015. When the clip magazine 77020 is retracted, onceagain, it will rotate once again, and thus, a third clip 77006 can bealigned with the slot 77036 of the clip advancer 77030. The third clip77006 can then be advanced by the clip advancer 77030 toward the loadingslot 77015 when the clip magazine 77020 is moved toward the distalposition.

Referring now to FIG. 455 , as the third clip 77006 is advanced into theloading slot 77015, the proximal feeder spring 77032 of the clipadvancer 77030 will advance the second clip 77005 from the loading slot77015 into the staging position 77017. Further, the clip 77004positioned in the staging position 77017 will be advanced by the distalfeeder spring 77034 into the clip track 77052. Referring now to FIG. 456, when the clip magazine 77020 is then retracted to the proximalposition, it will rotate and align a fourth clip 77007 with the slot77036 of the clip advancer 77030. The fourth clip 77007 can then beadvanced into the loading slot 77015 while the third clip 77006 in theloading slot 77015 is advanced into the staging position 77017 (see FIG.457 ). Further, while the fourth clip 77007 is advanced toward theloading slot 77015 the clips 77004, 77005 are advanced distally by thedistal feeder spring 77034 (see FIG. 457 ). More specifically, thedistal feeder spring 77034 engages the second clip 77005 and advancesthe second clip 77005 from the staging position 77017 into the cliptrack 77052. The second clip 77005 engages the backside of the clip77004 such that the second clip 77005 advances the clip 77004.

Further to the above, the clip magazine 77020 can be retracted to rotatethe clip magazine once again, which will align a fifth clip 77008 (seeFIG. 458 ) with the slot 77036 of the clip advancer 77030. The fifthclip 77008 can then be advanced into the loading slot 77015 while thefourth clip 77007 is advanced into the staging position 77017 and thethird clip 77006 is advanced into the clip track 77052. The third clip77006 engages the backside of the second clip 77005 and thus advancesthe second clip 77005 and the first clip 77004 through the clip track77052. The stroke of the clip advancer 77030 and clip magazine 77020 issuch that the clips are advanced through the clip track 77052 one cliplength at a time. Other embodiments are envisioned with different clipadvancer 77030 and clip magazine 77020 strokes, among other things.Further operation of the clip applier 77000 is discussed in greaterdetail below.

Referring primarily to FIGS. 458-460 , the clip applier 77000 furthercomprises a jaw cam 77060 configured to actuate the end effector 77050.The end effector 77050 comprises a first jaw 77054 and a second jaw77056 which at least partially define a receiving chamber 77055 thereinand are movable relative to each other between an open position and aclosed position. The end effector 77050 further comprises a proximalportion 77058 extending proximally from the first jaw 77054 and thesecond jaw 77056. The proximal portion 77058 is attached to the shaft77010 via a laterally extending pin fixed within the distal end of theshaft 77010 such that the end effector 77050 is mounted to the shaft77010. The jaw cam 77060 is configured to translate along the proximalportion 77058 of the end effector 77050 between a proximal position (seeFIG. 458 ) and a distal position (see FIG. 460 ). The jaw cam 77060 isthreadably engaged with a rotary input, such that rotation of the rotaryinput will translate the jaw cam 77060. The rotary input is operablyresponsive to rotary motions generated within the housing of clipapplier 77000. The jaw cam 77060 is rotatably constrained by theproximal portion 77058 of the end effector 77050, such that, when therotary input is rotated, the jaw cam 77060 is translated. The first jaw77054 and the second jaw 77056 remain in the open position when the jawcam 77060 is moved between the proximal position and the distalposition; however, the jaw cam 77060 can be moved beyond the distalposition to cammingly engage the first jaw 77054 and the second jaw77056 to move the first jaw 77054 and the second jaw 77056 toward theclosed position as described in greater detail below.

The jaw cam 77060 is slidably coupled to a feeder shoe 77062 extendingdistally from the jaw cam 77060. The jaw cam 77060 and the feeder shoe77062 are configured to advance a clip from the clip track 77052—if aclip is present in the clip track—into the receiving chamber 77055 ofthe end effector 77050. The jaw cam 77060 comprises a pin 77065extending into a slot 77064 of the feeder shoe 77062 (see FIG. 461 ).The feeder shoe 77062 further comprises a biasing member, such as aspring 77061, for example, extending proximally from the distal end ofthe slot 77064 which is engaged with the pin 77065 of the jaw cam 77060such that the feeder shoe 77062 is biased distally by the spring 77061.In other words, the spring 77061 acts to keep the pin 77065 positionedin the proximal end of the slot 77064.

Further to the above, when the jaw cam 77060 is moved from the proximalposition to the distal position the feeder shoe 77062 advances a clip—ifa clip is present in the clip track 77052—into the receiving chamber77055 of the end effector 77050. More specifically, when the jaw cam77060 translates distally, the distal end of the feeder shoe 77062engages the backside of a clip in the clip track 77052 to advance theclip (see FIG. 462 ). The biasing force of the spring 77061 is notovercome by translating the clip into the end effector 77050; thus, thefeeder shoe 77062 moves with the jaw cam 77060 as the jaw cam 77060translates to the distal position. When the jaw cam 77060 is moved tothe distal position, the feeder shoe 77062 is stopped from furtheradvancement by a distal stop 77057 protruding from the clip track 77052.More specifically, the feeder shoe 77062 comprises a protrusion 77063extending toward the clip track 77052 that engages the distal stop 77057to prevent further distal translation of the feeder shoe 77062. The jawcam 77060 can then be translated further, beyond the distal position, tocammingly engage the first jaw 77054 and the second jaw 77056 of the endeffector 77050 to crimp the clip positioned in the receiving chamber77055. In other words, the feeder shoe 77062 will not translate with thejaw cam 77060 when the jaw cam 77060 translates beyond the distalposition. As the rotary input continues to drive the jaw cam 77060distally, the biasing force of the spring 77061 is overcome and the pin77065 of the jaw cam 77060 will translate distally through the slot77064 of the feeder shoe 77062 as the feeder shoe 77062 is preventedfrom distally translating via the distal stop 77057. In such instances,the spring 77061 is compressed to allow the jaw cam 77060 to translatedistally without further advancing the feeder shoe 77062.

Further to the above, as the jaw cam 77060 retracts from beyond thedistal position to the distal position, the spring 77061 will bias thefeeder shoe 77062 proximally such that the pin 77065 is once againpositioned in the proximal end of the slot 77064. Also, the first jaw77054 and the second jaw 77056 will be moved from the closed position tothe open position to release the crimped clip from the end effector77050. The pin 77065 will remain in the proximal end of the slot 77064as the jaw cam 77060 is retracted from the distal position to theproximal positon due to the biasing force of the spring 77061 asdiscussed above. Thus, the jaw cam 77060 and feeder shoe 77062 areretractable together to position the feeder shoe 77062 behind anotherclip in the clip track 77052. More specifically, the distal end of thefeeder shoe 77062 comprises an angled portion 77067 which allows thefeeder shoe 77062 to slide up and over the next clip positioned in theclip track 77052. Further, the clip track 77052 comprises a proximalstop 77053 at its proximal end that prevents further proximaltranslation of the feeder shoe 77062, i.e., via the protrusion 77063 onthe feeder shoe 77062. The proximal stop 77053 ensures that the distalend of the feeder shoe 77062 is aligned with the backside of the nextclip in the clip track 77052.

The clip advancer 77030 and the jaw cam 77060 can be independentlysequenced, i.e., intermittently actuated by the motor, in order to movethe first jaw 77054 and the second jaw 77056 between the open and closedpositions without advancing a clip into the end effector 77050. In suchinstances, the clip advancer 77030 can be prevented from being actuatedwhile the jaw cam 77060 is being actuated. Thus, the jaw cam 77060 canopen and/or close the first jaw 77054 and the second jaw 77056 without aclip positioned in between the first jaw 77054 and the second jaw 77056until the clip advancer 77030 has been actuated. In at least oneinstance, the jaw cam 77060 can be utilized to open and/or close thefirst jaw 77054 and the second jaw 77056 a predetermined number of timesbefore the clip advancer 77030 is actuated to feed a clip. In certaininstances, after advancing a clip (or several clips) into the endeffector 77050 for crimping between the first jaw 77054 and the secondjaw 77056, the sequence between the jaw cam 77060 and the clip advancer77030 can be interrupted so as to not advance another clip into the cliptrack 77052. The jaw cam 77060 and feeder shoe 77062 can advance andcrimp the clip or clips remaining in the clip track 77052 until the cliptrack 77052 is empty. With the clip track 77052 empty, the jaw cam 77060can be moved between the proximal position and the distal position asneeded without the feeder shoe 77062 engaging a clip. The clip advancer77030 can then be actuated again to advance more clips into the cliptrack 77052 for engagement with the feeder shoe 77062. In other words,the clip applier 77000 is capable of intermittently advancing clips intothe end effector 77050 such that the first jaw 77054 and the second jaw77056 can be actuated with or without a clip present, even after a cliphas already been advanced and crimped.

FIGS. 463-465 depict a clip applier 77000′ in accordance with at leastone embodiment. The clip applier 77000′ is similar in many respects tothe clip applier 77000. More specifically, the clip applier 77000′comprises a jaw cam 77060′ configured to move the first jaw 77054 andthe second jaw 77056 of the end effector 77050 between the open positionand the closed position, as discussed above. The jaw cam 77060′comprises a body portion 77062′ configured to threadably engage a rotaryinput 77070′ that is operably responsive to rotary motions generatedinside the housing of the clip applier 77000′. As the rotary input77070′ is rotated, the jaw cam 77060′ will translate to move the firstjaw 77054 and the second jaw 77056 between the open position and theclosed position.

Further to the above, the body portion 77062′ comprises a protrusion77066′ extending laterally therefrom. The protrusion 77066′ isconfigured to extend into a proximal opening 77069′ of a clip advancer77064′ to releasably engage the body portion 77062′ with the clipadvancer 77064′. Other embodiments are envisioned where the clipadvancer 77064′ and the body portion 77062′ are releasably attachablewith a spring clip, or any other suitable means, for example. In anyevent, the clip advancer 77064′ comprises a feeder shoe 77067′ extendingdistally therefrom. The feeder shoe 77067′ is configured to advance aclip (one of the clips 77004, 77005, 77006, 77007, 77008, for example)from the clip track 77052 into the receiving chamber 77055 of the endeffector 77050 as the body portion 77062′ moves from a proximal position(FIG. 463 ) to a distal position (FIG. 464 ). During the translation ofthe body portion 77062′ between the proximal position and the distalposition, the first and second jaws 77054, 77056 are not approximated(i.e., they remain open).

Further to the above, the body portion 77062′ can advance beyond thedistal position (FIG. 464 ) to a closing position (see FIG. 465 ) inresponse to further rotation of the rotary input 77070′. As the bodyportion 77062′ moves toward the closing position, it will camminglyengage the outer surfaces of the first jaw 77054 and the second jaw77056 to move the first jaw 77054 and the second jaw 77056 toward theclosed position. Once the clip 77004 has been advanced into thereceiving chamber 77055, the distal end of the feeder shoe 77067′ of theclip advancer 77064′ is abutted against the clip 77004 and the clip77004 is abutted against a distal stop 77059 preventing further distaladvancement of the clip advancer 77064′. The distal stops 77059 arepositioned at the distal end of both the first jaw 77054 and the secondjaw 77056 and prevent the clip 77004 from translating distally out ofthe end effector 77050. Therefore, as the body portion 77062′ of the jawcam 77060′ is advanced beyond the distal position (FIG. 464 ) to theclosing position (FIG. 465 ), the protrusion 77066′ of the body portion77062′ moves from the proximal opening 77069′ of the clip advancer77064′ into a distal opening 77068′ of the clip advancer 77064′ becausethe clip advancer 77064′ is no longer translatable distally, asdiscussed above. In other words, the retention force between theproximal opening 77069′ and the protrusion 77066′ is overcome by thebody portion 77062′ when the body portion 77062′ is advanced from thedistal position (FIG. 464 ) toward the closing position (FIG. 465 ).Thus, the body portion 77062′ and clip advancer 77064′ are translatabletogether to advance a clip into the end effector 77050 and then the bodyportion 77062′ can be advanced further distally to move the first jaw77054 and the second jaw 77056 to the closed position without furtheradvancement of the clip advancer 77064′.

FIGS. 466-471 depict a clip applier 77100 in accordance with at leastone embodiment. The clip applier 77100 comprises a shaft 77120, a clipmagazine 77110, a clip advancer 77130, and a feeder shoe 77140. Theshaft 77120 extends from a housing of the clip applier 77100 and definesa shaft axis SA. The clip magazine 77110 is configured to translaterelative to the shaft 77120 between a proximal position (see FIGS. 467and 471 ) and a distal position (see FIG. 469 ) in response to therotational output of a motor within the housing of the clip applier77100. Similar to the above, the clip magazine 77110 is furtherconfigured to store a plurality of clips 77104 in a plurality of clipstorage positions 77112. The clip magazine 77110 further comprises aboss 77114 extending from its distal end. The clip advancer 77130 isrotatably mounted on the boss 77114 of the clip magazine 77110 such thatthe clip advancer 77130 is rotatable relative to the clip magazine 77110and translatable with the clip magazine 77110. The clip advancer 77130is configured to translate a clip 77104 through a clip track 77106 inresponse to a translation of the clip magazine 77110 as described ingreater detail below.

The shaft 77120 of the clip applier 77100 comprises an annular groove77124 on the inside diameter 77122 of the shaft 77120. The annulargroove 77124 is configured to slidably receive a protrusion 77138extending from a camming member 77132 of the clip advancer 77130. Theannular groove 77124 is defined in the inside diameter 77122 of theshaft 77120 to provide a spiral travel path for the protrusion 77138 ofthe camming member 77132. The spiral travel path of the annular groove77124 is in a first direction. The camming member 77132 extendslaterally relative to the shaft axis SA from a body portion 77131 of theclip advancer 77130. The camming member 77132 comprises an annular slot77134 configured to slidably receive a protrusion 77141 extending fromthe proximal end of the feeder shoe 77140. The annular slot 77134 isformed into the camming member 77132 to provide a spiral travel path forthe protrusion 77141 extending from the feeder shoe 77140. The spiraltravel path of the annular groove 77124 of the shaft 77120 and thespiral travel path of the annular slot 77134 of the camming member 77132are in opposite directions.

The clip advancer further comprises a recess 77136 between the cammingmember 77132 and the body portion 77131. The recess 77136 providesclearance for the feeder shoe 77140 to translate relative to the clipadvancer 77130. More specifically, when the protrusion 77141 of thefeeder shoe 77140 is captured in the annular slot 77134 of the cammingmember 77132, the feeder shoe 77140 is positioned within the recess77136.

Further to the above, the feeder shoe 77140 comprises a dovetail portion77144 extending from the distal end of the feeder shoe 77140. Thedovetail portion 77144 is captured in a longitudinal groove 77126defined in the inside diameter 77122 of the shaft 77120. Thelongitudinal groove 77123 comprises a complementary shape to thedovetail portion 77144 such that the dovetail portion 77144 is retainedwithin and slidable along the longitudinal groove 77123. The feeder shoe77140 further comprises a clip feeder 77146 extending downward from itsproximal end. The clip feeder 77146 is configured to feed a clip 77104through the clip track 77106 of the clip applier 77100 when the clipmagazine 77110 is translated distally as discussed in greater detailbelow.

Referring again to FIGS. 467-471 . The protrusion 77138 extending fromthe camming member 77132 is configured to travel through the annulargroove 77124 of the shaft 77120 and the protrusion 77141 of the feedershoe 77140 is configured to travel through the annular slot 77134 of thecamming member 77132 when the clip magazine 77110 is translated betweenits proximal position and its distal position. Referring primarily toFIG. 467 , the clip magazine 77110 is in the proximal position and aclip 77104 is abutted against the clip feeder 77146 of the feeder shoe77140. As the clip magazine 77110 is translated distally (see FIG. 468), the clip advancer 77130 will rotate due to the protrusion 77138 beingconstrained within the annular groove 77124 of the shaft 77120. Asdiscussed above, the feeder shoe 77140 is constrained to longitudinalmovement by the longitudinal groove 77126 and dovetail portion 77144 ofthe feeder shoe 77140. Thus, as the clip advancer 77130 rotates, theclip advancer 77130 will translate the feeder shoe 77140 distally due tothe sidewalls of the annular slot 77134 engaging the protrusion 77141 ofthe feeder shoe 77140 as the annular slot 77134 is rotated. As thefeeder shoe 77140 translates distally, the feeder shoe 77140 willtranslate the clip 77104 distally via the clip feeder 77146. Further,when the clip magazine moves from the proximal position to the distalposition, it moves through a stroke length SL₁ and the feeder shoe 77140moves through a stroke length SL₂ (see FIGS. 472 and 473 ). The strokelength SL₂ of the feeder shoe 77140 is twice the stroke length SL₁ ofthe clip magazine 77110. Other embodiments are envisioned where thestroke length SL₂ is more than or less than twice the stroke length SL₁,for example. In various instances, the pitches of the annular groove77124 and the annular slot 77134 can be constructed to modify the strokelengths SL₁ and SL₂, for example.

Further to the above, as the clip magazine 77110 translates into thedistal position (FIG. 469 ), the above-described rotation of the clipadvancer 77130 will continue until the protrusion 77138 of the clipadvancer 77130 reaches the end of the annular groove 77124—thuspreventing further rotation of the clip advancer 77130. Further, thedistal translation of the feeder shoe 77140 will continue until theprotrusion 77141 reaches the end of the annular slot 77134 of the clipadvancer 77130—thus preventing further distal translation of the feedershoe 77140. Correspondingly, the clip magazine 77110 can be translatedproximally toward the proximal position (see FIG. 470 ) to partiallyretract the feeder shoe 77140. Further proximal translation of the clipmagazine 77110 to the proximal position (see FIG. 471 ) will completelyretract the feeder shoe 77140.

FIGS. 474 and 475 depict a clip applier 77200 in accordance with atleast one embodiment. The clip applier 77200 comprises a shaft 77220extending from a housing of the clip applier 77200, a clip magazine77210 extending from the shaft 77220, a clip advancer 77230 extendingfrom the clip magazine 77210, a firing drive 77250, and an end effector77240. The clip magazine 77210 defines a magazine axis MA. The clipmagazine 77210 is configured to rotate about the magazine axis MA. Thefiring drive 77250 is also aligned with, and is rotatable about, themagazine axis MA in response to rotary motions generated by a motorwithin the housing of the clip applier 77200. The clip magazine 77210comprises clip holders 77212 circumferentially positioned approximately120 degrees apart about the magazine axis MA. The clip holders 77212 areconfigured to store a plurality of clips for clipping tissue. Each ofthe clip holders 77212 is configured to align with a clip track 77232 ofthe clip advancer 77230 as the clip magazine 77210 rotates about themagazine axis MA between a plurality of ejection positions. For example,one of the ejection positions is illustrated in FIG. 475 , i.e., a clipholder 77212 is aligned with the clip track 77232. When the clipmagazine 77210 is in an ejection position, the clip magazine 77210 isconfigured to bias a clip from the clip magazine 77210 into the cliptrack 77232. Once a clip is positioned in the clip track 77232, it canbe advanced into the end effector 77240 by a feeder shoe 77270. Thefeeder shoe 77270 is translatable through the clip track 77232 relativeto the shaft 77220 in response to rotary motions generated within thehousing of the clip applier 77200.

Further to the above, the end effector 77240 comprises a proximalportion 77245 configured to extend through a first opening 77234 in theclip advancer 77230 and a second opening 77216 in the clip magazine77210. The proximal portion 77245 comprises a first arm 77246 and asecond arm 77248 which extend through the first opening 77234 in theclip advancer 77230 and the second opening 77216 in the clip magazine77210. The end effector 77240 further comprises a proximal anchor 77249extending through the first opening 77234 in the clip advancer 77230 andthrough slots 77214 of the clip magazine 77210. The slots 77214 areradially disposed approximately 120 degrees apart within the clipmagazine 77210 about the magazine axis MA. The slots 77214 extend awayfrom the second opening 77216 to provide clearance for the proximalanchor 77249 of the end effector 77240. Further, the first arm 77246 andthe second arm 77248 are chamfered to provide clearance for the firingdrive 77250.

Further to the above, the end effector 77240 further comprises a firstjaw 77242 extending distally from the first arm 77246 of the proximalportion 77245, and a second jaw 77244 extending distally from the secondarm 77248 of the proximal portion 77245. The first arm 77246 and thesecond arm 77248 of the proximal portion 77245 are coupled together viaa collar 77260. The first arm 77246 and the second arm 77248 extend awayfrom each other, at least partially, due to their connection via theproximal anchor 77249. The collar 77260 is advanceable from a proximalposition to a distal position to move the first arm 77246 and the secondarm 77248 together, or toward one another. In such instances, the firstjaw 77242 and the second jaw 77244 are movable between an open position(as illustrated in FIG. 474 ) and a closed position in response to thedistal movement of the collar 77260. Further, the first jaw 77242 andthe second jaw 77244 extend down from a center plane CP (see FIG. 477 )of the proximal portion 77245 such that the firing drive 77250, thefirst arm 77246 and the second arm 77248 of the proximal portion 77245,and the first jaw 77242 and the second jaw 77244 are positioned ondifferent planes of the clip applier 77200. The first jaw 77242 and thesecond jaw 77244 at least partially define a receiving chamber 77241configured to receive a clip from the clip magazine 77210.

The above-described arrangement allows a clip to be fed into the jaws ofthe end effector 77240 along a plane that is offset from the magazineaxis MA. The jaws of the end effector are angled toward the magazineaxis MA at their distal end, as illustrated in FIG. 474 , to allow aclip positioned therein to be crimped in a plane that is closer to themagazine axis MA than the plane by which the clip was fed into the endeffector 77240. This allows a different input other than the feedershoe, such as the firing drive 77250, to extend through the clipmagazine 77210 while crimping the clips on a plane that is coincident,or close to coincident, with the magazine axis MA.

FIGS. 478 and 479 depict a clip applier 77300 in accordance with atleast one embodiment. The clip applier comprises an elongate tube 77320extending from a housing of the clip applier 77300, a clip magazine77310 housed within the elongate tube 77320, and an end effector 77340.The clip magazine 77310 comprises a central opening 77316 that defines amagazine axis MA. The clip magazine 77310 is configured to translatealong and rotate about the magazine axis MA. The clip magazine 77310further comprises clip slots 77312 radially disposed approximately 120degrees apart about the magazine axis MA. The clip slots 77312 areconfigured to store a plurality of clips which are biased out of theclip magazine 77310. The clips can be biased out of the clip magazine77310 by any suitable biasing member, including the biasing membersdiscussed herein, for example. The elongate tube 77320 further comprisesan opening 77322 which provides clearance for a clip from the clipmagazine 77310 to be biased from the clip magazine 77310 onto a cliptrack when one of the clip slots 77312 is aligned with the opening77322. The clip can be advanced through the clip track into the endeffector by a feeder shoe, as described herein.

Referring primarily to FIG. 478 , the end effector 77340 comprises afirst jaw 77342, a second jaw 77344, and a proximal portion 77345extending proximally from the first jaw 77342 and the second jaw 77344.The first jaw 77342 and the second jaw 77344 at least partially define areceiver 77341 configured to receive a clip from the clip track when theclip is advanced by the feeder shoe, as discussed above. The proximalportion 77345 is configured to attach the end effector 77340 to theelongate tube 77320. The proximal portion 77345 comprises a firstsupport 77346 extending proximally from the first jaw 77342 and thesecond jaw 77344. The first support 77346 is located below the magazineaxis MA, as discussed in greater detail below.

The proximal portion 77345 further comprises a second support 77348located between the magazine axis MA and the first support 77346. Otherembodiments are envisioned where the second support 77348 is located atand/or above the magazine axis MA, for example. In any event, theproximal portion 77345 comprises a U-shaped portion connecting the firstsupport 77346 and the second support 77348 at their proximal ends. Theelongate tube 77320 further comprises a lateral bar 77324 positioned atthe distal end of the elongate tube 77320 and spanning across the insidediameter 77326 of the elongate tube 77320. The U-shaped portion 77347 isconfigured to receive the lateral bar 77324 to connect the proximalportion 77345 of the end effector 77340 to the elongate tube 77320.

Further to the above, and with regard to FIGS. 480 and 481 , the clipapplier 77300 further comprises a collar 77360 mounted around the firstsupport 77346 of the proximal portion 77345 of the end effector 77340.The collar 77360 is formed around the first support 77346 after theproximal portion 77345 of the end effector 77340 is attached to theelongate tube 77320, as discussed above. More specifically, the collar77360 comprises a first bendable side 77364 and a second bendable side77365. The first bendable side 77364 comprises a groove 77366 and thesecond bendable side 77365 comprises a protrusion 77367. The first andsecond bendable sides 77364, 77365 are bent around the first support77346 and attached together below the first support 77346. Morespecifically, the protrusion 77367 engages the groove 77366 to slidablysecure the collar 77360 to the proximal portion 77345 of the endeffector 77340. In at least one alternative embodiment, the assembledcollar 77360 is attached to the end effector 77340 prior to attachingthe end effector 77340 to the elongate tube 77320. More specifically,the collar 77360, after being assembled in the above-described manner,is slid onto the proximal portion 77345 of the end effector 77340 priorto bending the second support 77348 relative to the first support 77346.Once the collar 77360 is attached to the proximal portion 77345, thesecond support 77348 can be bent relative to the first support 77346 toform the U-shaped portion 77347. The end effector 77340 is then attachedto the elongate tube 77320 in the above-described manner. Operation ofthe collar 77360 is discussed in greater detail below.

The collar 77360 is configured to cammingly engage the first jaw 77342and the second jaw 77344 as the collar 77360 moves from a proximalposition to a distal position. In such instances, the first jaw 77342and the second jaw 77344 are movable relative to each other between anopen position and a closed position as the collar 77360 moves from theproximal position to the distal position. The collar 77360 comprises aprotrusion 77362 extending toward the magazine axis MA. The protrusion77362 comprises a threaded aperture 77343 (see FIG. 480 ) that isthreadably engaged with a collar driver. The collar driver is configuredto move the collar 77360 between the proximal position and the distalposition in response to rotary motions generated within the housing ofthe clip applier 77300. The protrusion 77362 extends within an opening77349 in the second support 77348. In fact, the opening 77349 extendsinto the U-shaped portion 77347 to provide clearance for the collardriver to extend proximally through the central opening 77316 of theclip magazine 77310. This arrangement allows the clip magazine 77310 torotate about the magazine axis MA, while the collar 77360 is translatedalong an axis parallel to, but offset from, the magazine axis MA. Asillustrated in FIG. 479 , the jaws of the end effector 77340 are angledtoward the magazine axis MA at their distal end to allow a clippositioned therein to be crimped in a plane that is closer to themagazine axis MA than the plane by which the clip was fed into the endeffector 77340. This allows a different input other than the feedershoe, such as the collar driver, to extend through the clip magazine77310 while still allowing the clips to be crimped on a plane that iscoincident, or substantially coincident, with the magazine axis MA.

Referring now to FIG. 482 , an alternative end effector 77340′ for usewith the clip applier 77300 is depicted. The end effector 77340′ issimilar to the end effector 77340 in many respects. The end effector77340′ comprises a first protrusion 77342 a extending from the first jaw77342, and a second protrusion 77344 b extending from the second jaw77344. The first protrusion 77342 a and the second protrusion 77344 bare angled relative to one another such that their proximal ends arecloser together than their distal ends. The end effector 77340′ isconfigured for use with a cam member 77370 that comprises a first slot77372 oriented transversely relative to the first protrusion 77342 a anda second slot 77374 oriented transversely relative to the secondprotrusion 77344 b. The cam member 77370 is movable between a proximalposition and a distal position by a cam member driver in response torotary motions generated within the housing of the clip applier 77300.More specifically, the cam member driver is threadably engaged with thecam member 77370 via a threaded aperture 77376 defined in the cam member77370 such that, as the cam member driver rotates, the cam member 77370translates. As the cam member 77370 moves from the proximal position tothe distal position, the sidewalls of the first slot 77372 and thesecond slot 77374 will engage the protrusions 77342 a, 77344 b. Becausethe protrusions 77342 a, 77344 b are angled relative to the slots 77372,77374, the cam member 77370 will bias the first jaw 77342 and the secondjaw 77344 toward a closed position as the cam member 77370 moves fromthe proximal position to the distal position. Further, the cam member77370 will bias the first jaw 77342 and the second jaw 77344 toward anopen position as the cam member 77370 moves from the distal position tothe proximal position.

FIGS. 483 and 484 depict a clip applier 77400 in accordance with atleast one embodiment. The clip applier 77400 comprises a clip applierhead, or end effector 77420, for example, extending from a shaft. Theend effector 77420 comprises a top portion 77422, a bottom portion77424, and an intermediate portion 77426 connecting the top portion77422 and the bottom portion 77424. The top portion 77422 and the bottomportion 77424 are in two different parallel, or at least substantiallyparallel planes. The bottom portion 77424 comprises a pair of opposingjaws 77421 extending distally therefrom. The pair of opposing jaws 77421at least partially define a receiving chamber 77428 therein. Theopposing jaws 77421 are movable between an open position and a closedposition by way of a camming member 77440 slidably attached to thebottom portion 77424 of the end effector 77420. The camming member 77440is rotatably constrained by the bottom portion 77424 and is threadablyengage with a drive screw 77430. The drive screw 77430 comprises adistal thread portion 77434, a proximal thread portion 77432, and anintermediate portion 77436 connecting the distal thread portion 77434and the proximal thread portion 77432.

Further to the above, the intermediate portion 77436 of the drive screw77430 is rotatably supported by, but not threadably engaged with, anopening in the intermediate portion 77426 of the end effector 77420. Thedistal thread portion 77434 is threadably engaged with the cammingmember 77440 such that rotation of drive screw 77430 in a firstdirection will translate the camming member 77440 distally. In addition,the proximal thread portion 77432 is threadably engaged with a feedershoe 77450 such that rotation of the drive screw 77430 in the firstdirection will translate the feeder shoe 77450 proximally. In otherwords, the distal thread portion 77434 and the proximal thread portion77432 are threaded in opposite directions. Moreover, the distal threadportion 77434 comprises a smaller thread pitch than the proximal threadportion 77432. As a result, for a given rotation of the drive screw77430, the camming member 77440 will translate less than the feeder shoe77450, for example. As the drive screw 77430 is rotated in the firstdirection, the camming member 77440 will translate from a proximalposition (see FIG. 483 ) to a distal position (see FIG. 484 ) and thefeeder shoe 77450 will translate from a distal position (see FIG. 483 )to a proximal position (see FIG. 484 ). As the camming member 77440 ismoved toward the distal position, it will cammingly engage the pair ofopposing jaws 77421 and move the jaws 77421 to the closed position.Correspondingly, as the drive screw 77430 is rotated in a seconddirection, opposite the first direction, the camming member 77440 willtranslate from the distal position (see FIG. 484 ) to the proximalposition (see FIG. 483 ) and the feeder shoe 77450 will translate fromthe proximal position (see FIG. 484 ) to the distal position (see FIG.483 ). As the camming member 77440 is moved toward the proximalposition, the pair of opposing jaws 77421 will move to the openposition.

Further to the above, the clip applier 77400 further comprises a cliptrack 77410 configured to store a first clip 77404, a second clip 77405,and a third clip 77406. In at least one embodiment, the first clip77404, the second clip 77405, and the third clip 77406 can be fed intothe clip track 77410 by a clip magazine. The clips 77404, 77405, 77406are biased distally by a feeder block 77412 and a feeder spring 77413.The feeder shoe 77450 further comprises a feeder bar 77452 extendingdistally therefrom. The feeder bar 77452 comprises a first clip notch77454 located at the distal end thereof, and a second clip notch 77456located proximal to the first clip notch 77454. Operation of the clipapplier 77400 is described in greater detail below.

When the clip applier 77400 is initially loaded into a surgical sitethrough a trocar or cannula, for example (referring primarily to FIG.483 ), the opposing jaws 77421 can already have the first clip 77404positioned therein. In such instances, the second clip 77405 and thethird clip 77406 are located in the clip track 77410 and biased distallyby the feeder spring 77413. The second clip 77405 and the third clip77406 are held in place by the second clip notch 77456 of the feeder bar77452. The biasing force in this position from the feeder spring 77413is not enough to force the second clip 77405 out of the second clipnotch 77456 as the spring is in an expanded position. As the drive screw77430 is rotated in the first direction, the opposing jaws 77421 willmove toward the closed position and the feeder shoe 77450 will movetoward the proximal position, as discussed above. As the feeder shoe77450 is moved toward the proximal position, the first clip 77404 willbe crimped and the feeder shoe 77450 will retract the second clip 77405and the third clip 77406 proximally while compressing the feeder spring77413. The second and third clips 77405, 77406 will retract proximallyuntil the biasing force from the feeder spring 77413 overcomes theretention force between the second clip 77405 and the second clip notch77456. At this point, the second clip 77405 will slide by the secondclip notch 77456. However, the first clip notch 77454 will catch thesecond clip 77405. Moreover, the third clip 77406 will follow the secondclip 77405 by the second clip notch 77456 such that the feeder spring77413 is pushing on the second clip 77405 via the third clip 77406.

After the first clip 77404 has been crimped it can be released from thereceiving chamber 77428 by rotating the drive screw 77430 in the seconddirection. As discussed above, when the drive screw 77430 is rotated inthe second direction, the opposing jaws 77421 of the end effector 77420will move to the open position and the feeder shoe 77450 will movetoward the distal position. As the feeder shoe 77450 moves toward thedistal position the feeder bar 77452 will carry the second and thirdclips 77405, 77406 distally. The second and third clips 77405, 77406will remain biased into the first clip notch 77454 by the feeder spring77413 until the distal end of the feeder shoe 77450 approaches thereceiving chamber 77428 of the end effector 77420. The distal end of thefeeder shoe 77450 is configured to curve, or bend, upwardly as itapproaches the receiving chamber 77428 of the end effector 77420 and, asa result, the second clip 77405 is released from the first clip notch77454. Once the second clip 77405 is released, the feeder spring 77413biases the second clip 77405 into the receiving chamber 77428 of the endeffector 77420. At the same time, the third clip 77406 is biaseddistally by the feeder spring 77413 but cannot enter the receivingchamber 77428 because the receiver is occupied by the second clip 77405.In such instances, the third clip 77406 is staged for the next actuationof the clip applier as described below.

Further to the above, the drive screw 77430 can now be rotated in thefirst direction to crimp the second clip 77405 positioned in thereceiving chamber 77428 and retract the feeder bar 77452 via the feedershoe 77450, as discussed above. As the feeder bar 77452 is retracted,the first clip notch 77454 will engage the third clip 77406 and retractthe third clip 77406 proximally (see FIG. 484 ). At this stage, thefeeder shoe 77450 is in the proximal position once again, the cam member77440 is in the distal position once again, the second clip 77405 hasbeen crimped by the opposing jaws 77421, and the third clip 77406 hasbeen retracted. The drive screw 77430 can now be rotated in the firstdirection to release the second clip 77405 from the opposing jaws 77421of the end effector 77420 and to advance the third clip 77406 into theopposing jaws 77421 by way of the feeder bar 77452, in the mannerdiscussed above in connection with the second clip 77405. The third clip77406 can then be crimped by rotating the drive screw 77430 in thesecond direction and then the crimped third clip 77406 can be releasedfrom the opposing jaws 77421 by rotating the drive screw 77430 in thefirst direction.

The above-discussed embodiment of FIGS. 483 and 484 comprises a systemfor automatically loading a plurality of clips into an end effectorafter the first clip has been crimped and released. The clips loadedinto the end effector are then sequentially crimped and released.

FIGS. 485 and 486 depict a clip applier 77500 in accordance with atleast one embodiment. The clip applier comprises an end effector 77520,an actuator 77510, and a drive screw 77530 extending proximally from theactuator 77510. The actuator 77510 comprises a drive bar 77511 and athreaded nut 77514 at the proximal end of the drive bar 77511. The drivebar 77511 comprises internal threads 77512 configured to receive theexternal threads 77532 of the drive screw 77530. The actuator 77510 isrotatably constrained within a shaft of the clip applier 77500 by thethreaded nut 77514 thus, the drive screw 77530 can be rotated totranslate the actuator 77510 between a proximal position (FIG. 485 ) anda distal position (FIG. 486 ). The drive screw 77530 is rotatable abouta drive axis DA in response to rotary motions generated by a motor ofthe clip applier 77500. The drive screw 77530 comprises a pair oflaterally-extending pins 77516 which extend away from the drive bar77511 of the actuator. The end effector 77520 comprise a first jaw 77522and a second jaw 77524 movable relative to each other between an openposition (FIG. 485 ) and a closed position (FIG. 486 ). The first jaw77522 and the second jaw 77524 at least partially define a receivingchamber 77521 between an inner surface 77518 of the first jaw 77522 andan inner surface 77519 of the second jaw 77524. The first jaw 77522 andthe second jaw 77524 are discussed in greater detail below.

The first jaw 77522 comprises a first cam member 77526. The second jaw77524 comprises a second cam member 77528. The first cam member 77526comprises a first pair of parallel slots 77527 that are angledtransverse to the drive axis DA. The second cam member 77528 comprises asecond pair of parallel slots 77529 that are angled transverse to thedrive axis DA. The first pair of parallel slots 77527 are transverse tothe second pair of parallel slots 77529. The laterally-extending pins77516 of the actuator 77510 are received in the first pair of parallelslots 77527 and the second pair of parallel slots 77529. In addition,the first cam member 77526 comprises a lateral slot 77523 located at theproximal end of the first cam member 77526. The second cam member 77528comprises a protrusion, or pin 77525, extending into the lateral slot77523 of the first cam member 77526. Operation of the clip applier 77500is discussed in greater detail below.

As discussed above, the rotation of the drive screw 77530 translates theactuator 77510. As the actuator 77510 translates from the proximalposition to the distal position, the laterally-extending pins 77516 willengage the sidewalls of the first pair of slots 77527 and the secondpair of slots 77529 to move the end effector from its open position toits closed position. Notably, the first jaw 77522 and the second jaw77524 close in a parallel manner. Stated another way, the first jaw77522 and the second jaw 77524 are translated closed, not rotatedclosed. This motion is controlled by the arrangement of thelaterally-extending pins 77516 and the pin 77525.

FIGS. 487 and 488 depict a clip applier 77600 in accordance with atleast one embodiment. The clip applier comprises a shaft 77640 extendingfrom a housing of the clip applier 77600. The shaft 77640 defines ashaft axis SA. The clip applier 77600 further comprises an end effector77620, an actuator 77650, and a drive screw 77660 extending proximallyfrom the actuator 77650. The actuator 77650 comprises a boss 77658 atits proximal end. The boss 77658 comprises an internal thread configuredto receive the drive screw 77660; thus, the drive screw 77660 isthreadably engaged with the actuator 77650. The actuator 77650 isrotatably constrained within the shaft 77640, such that, the actuator77650 is translated between a distal position (FIG. 487 ) and a proximalposition (FIG. 488 ) when the drive screw 77660 is rotated. The drivescrew 77660 is rotatable about the shaft axis SA in response to rotarymotions generated by a motor of the clip applier 77600.

Further to the above, the end effector 77620 comprise a first jaw 77622and a second jaw 77632 movable relative to each other between an openposition (FIG. 487 ) and a closed position (FIG. 488 ). The first jaw77622 and the second jaw 77632 at least partially define a receivingchamber 77621 between an inner surface 77623 of the first jaw 77622 andan inner surface 77633 of the second jaw 77632. The first jaw 77622comprises a first cam member 77624 extending proximally from the firstjaw 77622. The second jaw 77632 comprises a second cam member 77634extending proximally from the second jaw 77632. The first cam member77624 comprises a first slot 77626 that is angled transverse to theshaft axis SA. More specifically, the first slot 77626 comprises adistal portion extending in one direction and a proximal portionextending in another direction. The second cam member 77634 comprises asecond slot 77636 that is transverse to the shaft axis SA. Morespecifically, the second slot 77636 comprises a distal portion extendingin one direction and a proximal portion extending in another direction.The first slot and the second slot overlap to form an X-shape asillustrated in FIG. 487 .

The actuator 77650 comprises a distal slot 77654, a proximal slot 77656,and a distal protrusion 77652. The distal slot 77654 is transverse tothe shaft axis SA in a first direction, and the proximal slot 77656 istransverse to the shaft axis SA in a second direction, opposite thefirst direction. The distal protrusion 77652 of the actuator 77650 isconfigured to be slidably received in the first slot 77626 and thesecond slot 77636. Further, the first cam member 77624 comprises a firstcam protrusion 77628 located at the proximal end of the first cam member77624. The second cam member 77634 comprises a second cam protrusion77638 located at the proximal end of the second cam member 77634. Thefirst cam protrusion 77628 is located proximal to the second camprotrusion 77638. The first cam protrusion 77628 is configured to beslidably received in the proximal slot 77656 of the actuator 77650 andthe second cam protrusion 77638 is configured to be slidably received inthe distal slot 77654 of the actuator 77650. Operation of the clipapplier 77600 is discussed in greater detail below.

As discussed above, the rotation of the drive screw 77660 results intranslation of the actuator 77650. As the actuator 77650 translates fromthe distal position (FIG. 487 ) to the proximal position (FIG. 488 ),the distal protrusion 77652 of the actuator 77650 will move proximally adistance Dl. As the distal protrusion 77652 moves proximally, the distalprotrusion 77652 engages the sidewalls of the first slot 77626 and thesecond slot 77636 which are moved toward each other. Further, as theactuator 77650 moves proximally, the distal slot 77654 and the proximalslot 77656 will move proximally resulting in the second cam protrusion77638 and the first cam protrusion 77628 moving transversely to theshaft axis SA in opposite directions. More specifically, the first camprotrusion 77628 will move distally along the shaft axis SA andtransverse to the shaft axis SA in a first direction FD. Further, thesecond cam protrusion 77638 will move distally along the shaft axis SAand transverse to the shaft axis SA in a second direction SD. As thefirst cam protrusion 77628 moves in the first direction FD and thesecond cam protrusion 77638 moves in the second direction SD, the firstjaw 77622 and the second jaw 77632 will move toward the closed positionillustrated in FIG. 488 . More specifically, the distal end of the innersurface 77623 of the first jaw 77622 and the distal end of the innersurface 77633 of the second jaw 77632 will move toward each other. Thus,the inner surface 77623 of the first jaw 77622 and the inner surface77633 of the second jaw 77632 are not parallel when the first jaw 77622and the second jaw 77632 are in the closed position. In other words, theend effector 77620 has tip-first closure of the jaws as compared to theend effector 77520 which has parallel closure of the jaws.

FIGS. 489-492 depict a clip applier 77700 in accordance with at leastone embodiment. The clip applier 77700 comprises an end effector 77720,a clip magazine 77710, a clip feeding system 77730, and a jaw camassembly 77740. The end effector 77720 comprises a pair of opposing jaws77721 configured to move between an open position and a closed position,as described herein. The clip magazine 77710 and the jaw cam assembly77740 are actuatable via two separate rotary inputs. The clip magazine77710 is similar to the clip magazine 76010 of the clip applier 76000(see FIG. 424 ). The clip magazine 77710 comprises a plurality of clips77714 stored in a plurality of clip holders 77718. The clip magazine77710 is rotatable and translatable via a magazine driver 77716 that isoperably responsive to a first rotary input 77712. The first rotaryinput 77712 is operably responsive to rotary motions generated within ahousing of the clip applier 77700. In any event, the clip magazine 77710is configured to be advanced and retracted to strip the clips 77714 fromthe clip magazine 77710 into a loading slot, such as loading slot 77722of end effector 77720.

The jaw cam assembly 77740 comprises a jaw cam 77742 that is threadablyengaged with a second rotary input 77744. The second rotary input 77744is operably responsive to rotary motions generated within the housing ofthe clip applier 77700. The second rotary input 77744 is configured totranslate the jaw cam 77742 between a fully-advanced position (FIG. 492), a retracted position (FIG. 490 ), and a fully-retracted position(FIG. 491 ). The jaw cam 77742 is configured to interact with theopposing jaws 77721 of the end effector 77720 to move the opposing jaws77721 between the open position and the closed position. Morespecifically, the jaw cam 77742 comprises a cam window 77743 (see FIG.493 ) configured to be receive over a proximal portion 77723 of theopposing jaws 77721. The first rotary input 77712 and the second rotaryinput 77744 are operable independently of one another by a motor controlsystem of the clip applier 777000.

When the jaw cam 77742 is in its fully-advanced position (FIG. 492 ),the opposing jaws 77721 of the end effector 77720 are in their closedposition. More specifically, as the jaw cam 77742 moves toward thefully-advanced position the cam window 77743 of the jaw cam 77742 willcammingly engage the exterior of the opposing jaws 77721 to move theopposing jaws 77721 to the closed position. When the jaw cam 77742 is inits retracted position (FIG. 490 ) or the fully-retracted position (FIG.491 ), the opposing jaws 77721 are in their open position. The opposingjaws 77721 are biased away from each allowing the opposing jaws 77721 tomove to the open position when the jaw cam 77742 is not holding theopposing jaws 77721 together. The opposing jaws 77721 can be movedbetween the open and closed position without performing clip feed orclip magazine functions.

The above being said, the jaw cam 77742 is also used to release the clipfeeding system 77730 such that a clip is fed into the end effector77720. As described below, the jaw cam 77742 is retracted from itsretracted position to its fully-retracted position to release a feedershoe 77732 which is pushed distally by a feeder spring 77734.

Referring now to FIGS. 493 and 494 , the jaw cam 77742 further comprisesa shoe release latch 77746 positioned thereon. The shoe release latch77746 is biased toward the jaw cam 77742 by a biasing member 77748. Theshoe release latch 77746 comprises a protrusion 77747 on its distal endthat extends through a top opening 77745 in the jaw cam 77742 and downinto the cam window 77743 of the jaw cam 77742. The protrusion 77747comprises a chamfered portion 77747 a on the distal end of the shoerelease latch 77746. The shoe release latch 77746 further comprises achamfered portion 77749 on its proximal end.

Further to the above, the clip feeding system 77730 comprises the feedershoe 77732, a release latch 77731, and the feeder spring 77734. In itsstored position, the feeder shoe 77732 is biased away from a proximalstop 77750 of the clip applier 77700 by the feeder spring 77734, butheld in place by the release latch 77731 (see FIG. 489 ).

When the clip applier 77700 is in an initial position (e.g., when theclip applier 777000 is placed into a surgical site), the opposing jaws77721 of the end effector 77720 can be in the closed position (see FIG.489 ). In such instances, the feeder shoe 77732 is held in its stored,or ready-to-be-fired position, as described above.

When the jaw cam 77742 is retracted to the retracted position (FIG. 490) to open the opposing jaws 77721, the loading slot 77722 can receiveone of the clips 77714 from the clip magazine 77710. The jaw cam 77742can then be retracted to the fully-retracted position (FIG. 491 ) torelease the feeder shoe 77732 and advance the clip 77714 into theopposing jaws 77721 of the end effector 77720. More specifically, as thejaw cam 77742 is retracted to the fully-retracted position (FIG. 491 ),the jaw cam 77742 engages a front side 77738 of the release latch 77731to rotate the release latch 77731 away from the feeder shoe 77732.Further, as the jaw cam 77742 is moved to the fully-retracted position,the shoe release latch 77746 engages the proximal stop 77750 which movesthe shoe release latch 77746 in an upward direction UD (see FIG. 494 )providing clearance for the feeder shoe 77732 to be advanced toward theend effector 77720.

After the clip 77714 has been advanced into the end effector 77720, thejaw cam 77742 is moved to its fully-advanced position (see FIG. 492 ) tomove the opposing jaws 77721 of the end effector 77720 to their closedposition to crimp the clip 77714 positioned in the end effector 77720.Notably, the jaw cam 77742 carries the shoe release latch 77746 distallyto engage the feeder shoe 77732 once again. More specifically, as thejaw cam 77742 moves toward the fully-advanced position, the chamferedportion 77747 a on the distal end of the shoe release latch 77746engages the proximal end of the feeder shoe 77732 such that the shoerelease latch 77746 is biased in the upward direction UD. When the jawcam 77742 is in the fully-advanced position, the shoe release latch77746 moves downward toward the feeder shoe 77732 by the biasing member77748. In other words, as the jaw cam 77742 is moved toward thefully-advanced position, the shoe release latch 77746 can move up andover the feeder shoe 77732 to engage a distal side of the feeder shoe77732.

The jaw cam 77742 can now be used to retract the feeder shoe 77732. Thefeeder shoe 77732 is re-engaged with the release latch 77731 when thejaw cam 77742 reaches its retracted position (FIG. 490 ).

When the feeder shoe 77732 is engaged with the release latch 77731, thejaw cam 77742 can translate freely between the retracted position FIG.489 and the fully-advanced position (FIG. 492 ) to actuate the opposingjaws 77721 of the end effector 77720, as discussed herein. The opposingjaws 77721 can be opened and closed without having to feed and/or crimpa clip. Such opening and closing is often needed to position the endeffector of the clip applier within the patient. This is possible, inpart, owing to the fact that the clip feeding system isn't triggeredwithin the closing stroke of the jaw cam system. Rather, as describedabove, the clip feeding system is actuated only when the jaw cam isfully-retracted, i.e., retracted proximally behind the position of thejaw cam associated with the fully-open position of the opposing jaws.Once the jaw cam 77742 is moved to the retracted position (FIG. 490 ),another clip 77714 can be positioned in the loading slot 77722 from theclip magazine 77710 and this clip 77714 can be advanced into the endeffector 77720 by the feeder shoe 77732 and crimped by the opposing jaws77721, as discussed above. This process can continue until all of theclips 77714 have been spent from the clip magazine 77710.

FIGS. 495-500 depict a clip applier 77800 in accordance with at leastone embodiment. The clip applier 77800 comprises an end effector 77820,a clip track 77840, a cam member 77850, a clip advancer 77860, and arotary input 77870. The rotary input 77870 defines a rotary axis RA andis rotatable about the rotary axis RA in response to rotary motionsgenerated by a motor within a housing of the clip applier 77800. Therotary input 77870 comprises a proximal threaded portion 77872 and adistal threaded portion 77874 extending from the proximal threadedportion 77872. The proximal threaded portion 77872 comprises a largerthread pitch than the distal threaded portion 77874; however, anysuitable thread pitches could be used.

The end effector 77820 extends distally from the clip track 77840 and ismounted to the clip track 77840 via a mounting member 77830. Themounting member 77830 extends above the clip track 77840 and in-betweena first jaw 77822 and a second jaw 77824 of the end effector 77820. Thefirst jaw 77822 and the second jaw 77824 are movable relative to eachother between an open position (FIGS. 497 and 500 ) and a closedposition (FIGS. 495 and 498 ). The first jaw 77822 and the second jaw77824 at least partially define a receiving chamber 77826 there between.Further, the mounting member 77830 comprises a pair oflaterally-extending pins 77832. Each of the first jaw 77822 and thesecond jaw 77824 comprises holes 77829 configured to slidably receivethe pair of laterally-extending pins 77832 of the mounting member 77830.Thus, the first jaw 77822 and the second jaw 77824 are movable laterallyrelative to each other along the laterally-extending pins 77832.

The first jaw 77822 comprises a first pin 77827 extending upwardintermediate the holes 77829 in the first jaw 77822. Further, the secondjaw 77824 comprises a second pin 77828 extending upward intermediate theholes 77829 in the second jaw 77824. The first pin 77827 is slidablyreceived in a first slot 77852 of the cam member 77850, and the secondpin 77828 is slidably received in a second slot 77854 of the cam member77850. The first slot 77852 comprises a longitudinal portion 77856 and atransverse portion 77857. The longitudinal portion 77856 is parallel tothe rotary axis RA of the rotary input 77870 and the transverse portion77857 is transverse to the rotary axis RA of the rotary input 77870.Similarly, the second slot 77854 comprises a longitudinal portion 77858and a transverse portion 77859. The longitudinal portion 77858 isparallel to the rotary axis RA of the rotary input 77870 and thetransverse portion 77859 is transverse to the rotary axis RA of therotary input 77870. The transverse portions 77857 and 77859 extendtoward the rotary axis RA from the longitudinal portions 77856 and77858.

Further to the above, the cam member 77850 further comprises aprotrusion 77851 extending upward from its proximal end. The protrusion77851 comprises an internal thread 77853 (see FIG. 500 ) that isthreadably engaged with the distal thread portion 77874 of the rotaryinput 77870. Similarly, the clip advancer 77860 comprises a protrusion77862 extending upward from its proximal end. The protrusion 77862comprise an internal thread 77864 that is threadably engaged with theproximal threaded portion 77872 of the rotary input 77870. Both theprotrusion 77851 of the cam member 77850 and the protrusion 77862 of theclip advancer 77860 are rotatably constrained within a slot 77882 of atop housing 77880 of the clip applier 77800. The slot 77882 allows forthe cam member 77850 and the clip advancer 77860 to translate along therotary axis RA as the rotary input 77870 is rotated about the rotaryaxis RA. As discussed above, the proximal thread portion 77872 of therotary input 77870 comprises a larger thread pitch than the distalthread portion 77874 of the rotary input 77870. Thus, rotation of therotary input 77870 will translate the clip advancer 77860 through a clipadvancement stroke and will translate the cam member 77850 through a jawclosure stroke that is smaller than the clip advancement stroke. Inother words, rotation of the rotary input 77870 will translate the clipadvancer 77860 a greater distance than it will translate the cam member77850. The clip advancer 77860 further comprises a feeder shoe 77866extending downward from the clip advancer 77860. The feeder shoe 77866is configured to translate through a loading slot 77842 of the cliptrack 77840 as the clip advancer 77860 is translated via the rotaryinput 77870. The loading slot 77842 is configured to store a pluralityof clips 77804 in a longitudinal row for sequential advancement into thereceiving chamber 77826 of the end effector 77820. The operation of theclip applier 77800 is discussed in greater detail below.

In an initial position, the first jaw 77822 and the second jaw 77824 arein the closed position without a clip 77804 placed between them, suchinstances can occur, when the clip applier 77800 is first loaded into asurgical site. Also in such instances, both the clip advancer 77860 andthe cam member 77850 are in their proximal position (see FIGS. 495 and498 ), for example. When the rotary input 77870 is rotated in a firstdirection FD, the clip advancer 77860 and cam member 77850 translatedistally to intermediate positions to move the first jaw 77822 and thesecond jaw 77824 into the open position and to advance a clip 77804through the clip track 77840 to a position just proximal to thereceiving chamber 77826 of the end effector 77820. When the cam member77850 is translated distally from its proximal position to thisintermediate position (FIGS. 496 and 499 ), as described above, thetransverse portions 77857 and 77859 of the first and second slots 77852and 77854 of the cam member 77850 engage the first and second pins 77827and 77828 of first and second jaws 77822,77824 and move the first andsecond pins 77827 and 77828 away from each other until the first andsecond pins 77827 and 77828 move into the longitudinal portions 77856and 77858 of the first and second slots 77852,77854 (see FIG. 496 ).

As discussed above, the first and second pins 77827 and 77828 extendupward from the first and second jaws 77822 and 77824, and the first andsecond jaws 77822 and 77824 are slidable relative to each other alongthe pair of laterally-extending pins 77832 of the mounting member 77830.Thus, as the cam member 77850 is moved distally from its proximalposition to this intermediate position, the first jaw 77822 and thesecond jaw 77824 are moved to their open position. Further, the firstclip 77804 is advanced to a position just proximal to the receivingchamber 77826 by the feeder shoe 77866 of the clip advancer 77860 whenthe clip advancer 77860 is moved from its proximal position (FIG. 498 )to this intermediate position (FIG. 499 ). In other words, the rotaryinput 77870 can be rotated in the first direction FD to move the firstand second jaws 77822 and 77824 to the open position without advancing aclip 77804 into the end effector 77820.

When the clip advancer 77860 and cam member 77850 are in theirintermediate positions (FIGS. 496 and 499 ), the rotary input 77870 canbe rotated further in the first direction FD to translate the clipadvancer 77860 and the cam member 77850 further distally to advance thefirst clip 77804 into the receiving chamber 77826 of the end effector77820. More specifically, the cam member 77850 can be moved from theintermediate position (FIG. 496 ) to a distal position (FIG. 497 ) andthe clip advancer 77860 can be moved from the intermediate position(FIG. 496 ) to a distal position (FIG. 497 ). As the cam member 77850 ismoved toward the distal position, the first and second pins 77827 and77828 of the first and second jaw 77822 and 77824 will move through thelongitudinal portions 77856 and 77858 of the first and second slots77852 and 77854 of the cam member 77850 and the first and second jaws77822, 77824 are not driven laterally. As the clip advancer 77860 ismoved toward the distal position, the feeder shoe 77866 of the clipadvancer 77860 will advance the first clip 77804 into the receivingchamber 77826 defined between the first and second jaws 77822 and 77824.The feeder shoe 77866 is angled such that it will also advance thesecond clip 77804 distally to a position just proximal to the receivingchamber 77826.

Once the first clip 77804 has been advanced into the receiving chamber77826, the rotary input 77870 can be rotated in the second direction toretract the clip advancer 77860 and cam member 77850 to theirintermediate positions. When the clip advancer 77860 and cam member77850 are moved into their intermediate positions, the first and secondjaws 77822 and 77824 will remain in the open position and the feedershoe 77866 of the clip advancer 77860 is retracted proximally beyond thereceiving chamber 77826. Thus, the feeder shoe 77866 will not interferewith the crimping of the first clip 77804 positioned in the receivingchamber 77826.

Further to the above, the rotary input 77870 can be rotated furtherstill in the second direction to retract the clip advancer 77860 and cammember 77850 from their intermediate positions to their proximalpositions. When the clip advancer 77860 and cam member 77850 are movedtoward their proximal positions, the first and second jaws 77822 and77824 move to the closed position to crimp the first clip 77804positioned therebetween. Further, the clip advancer 77860 movesproximally such that the feeder shoe 77866 moves proximally beyond thesecond clip 77804 positioned in the clip track 77840 just proximal tothe receiving chamber 77826. The distal end of the feeder shoe 77866 isangled such that the feeder shoe 77866 can move up and over the secondclip 77804 into position behind the second clip 77804. The first andsecond jaws 77822 and 77824 can then be moved to the open position torelease the first clip 77804 from the first and second jaws 77822 and77824 while the second clip 77804 is advanced into the receiving chamber77826. The second clip 77804 can then be crimped and released while athird clip 77804 is advanced into the receiving chamber 77826, and soforth.

Referring to FIG. 501 , a graph 78000 of the displacement of a crimpingdrive of a clip applier system at various set points over time isdepicted. The crimping drive is configured to crimp a clip 78004positioned in between the jaws of an end effector, as discussed herein.The crimping drive is operably responsive to a motor of the clip appliersystem configured to generate rotary motions. Further, the motor iscontrollable by a motor controller comprising a processor and a memoryin signal communication with the processor. The motor controller isconfigured to detect the current draw of the motor, compare the detectedcurrent to pre-determined ranges of current stored in the memory of themotor controller, and then adjust the speed and/or force of the crimpingdrive based on the detected current. The pre-determined ranges ofcurrent stored in the memory can be based on the expected amount ofcurrent draw on the motor for various clip formations. This informationcan be programmed into the motor controller when it is manufacturedand/or from a surgical hub, as described in greater detail below.

As the crimping drive is moved from distance δ₀ to distance δ_(A),referring still to FIG. 501 , the clip 78004 positioned in the endeffector is configured to be crimped by the crimping drive such that thedistal ends of the legs of the clip touch at set point 78010. This typeof formation is called, tip first, however other types of formation canbe used. As the crimping drive is moved from distance δ_(A) to distanceδ_(B), the clip is further formed at set point 78020. As the crimpingdrive is moved from distance δ_(B) to distance δ_(C), the clip iscompletely formed at set point 78030. Each orientation of the clip 78004at set points 78010, 78020, and 78030 can be detected by the motorcontroller based on the current draw of the motor and/or any otherperformance characteristic of the motor. With this data, the motorcontroller can adapt the operation of the motor to achieve a desiredresult. For instance, when the ends of the legs of the clip 78004 touch(e.g., at set point 78010), the motor controller will likely detect anincrease in the current draw of the motor due to the force required toform the clip beyond the configuration shown at set point 78010. As theclip 78004 is further formed to the orientation depicted at set point78020, the current draw will likely increase further as the forcerequired to crimp the clip 78004 will increase further owing to theresistance of the tissue and the additional deformation of the clip78004. As the clip 78004 is fully formed (e.g., at point 78030), thecurrent draw of the motor will significantly increase as the clip 78004cannot be formed further. The current draw on the motor at each of theseset points 78010, 78020, 78030 can be compared to the pre-determinedranges of current stored in the memory of the motor controller todetermine how the motor controller is to proceed, as described ingreater detail below.

At set point 78010, further to the above, the motor controller candirect the motor to continue advancing the crimping drive from distanceδ_(A) to δ_(B) or δ_(C) to further form the clip. Additionally, themotor controller can direct the motor to dwell for a set period of timeat set point 78010 (e.g., from t_(A) to t_(x), for example) and theneither retract the crimping drive from distance δ_(A) to distance δ₀ torelease the clip 78004 or advance the crimping drive from distance δ_(A)to distance δ_(B) or distance δ_(C) to further crimp the clip 78004. Themotor controller can direct the motor to perform similar functions ateach set point 78010, 78020, and 78030. For example, at set point 78020,the motor controller can direct the motor to continue to advance thecrimping drive from distance δ_(B) to distance δ_(C) to further form theclip. Additionally, at set point 78020, the motor controller can directthe motor to dwell for a set period of time (e.g., from t_(b) to t_(D),for example) and then either retract the crimping drive from distanceδ_(B) to distance δ₀ to release the clip 78004 or advance the crimpingdrive from distance δ_(B) to distance δ_(C) to completely crimp the clip78004, for example.

The current draws expected at each of the set points 78010, 78020, 78030can be pre-programmed into the memory of the motor controller such thatthe motor controller will automatically stop the motor when the currentdraw on the motor is indicative of one of the set points 78010, 78020,78030. The motor controller can then require a manual input from theuser of the clip applier system in order to proceed. Thus, a user of theclip applier system can selectively determine how much to deform theclip 78004 and when to release the clip 78004 such that varying rangesof clip formation are possible depending on the pre-programmed setpoints 78010, 78020, 78030. Further, the motor controller can beconfigured to slow down the motor, pause the motor, or speed up themotor at each set point based on the manual input from the user. Morespecifically, once a set point 78010, 78020, 78030 is reached the motorwill be paused and/or stopped, the user can then select a slow motionbutton (e.g., some form of actuator, for example) on the clip applier todirect the motor controller to slowly advance the crimping drive fromone set point to another or the user can select a fast motion button, oractuator, to direct the motor controller to more quickly advance thecrimping drive.

In previous devices, the opening and closing of the jaws of a clipapplier resulted in a clip being automatically cycled, i.e., fed intothe jaws and then crimped. In many instances, such an arrangement issuitable; however, many instances can arise where cycling a clip resultsin the clip being dropped into the patient, or otherwise wasted. Forinstance, when the jaws are closed to insert the clip applier through atrocar and then re-opened inside the patient, a clip is crimped and thendropped into the patient when the jaws are opened. In many embodimentsdescribed herein, the clip feeding system and the jaw drive system of aclip applier are operated by separate and distinct drive systems. Insuch embodiments, the clip feeding system can be deactivated while thejaw drive system is cycled. Such an arrangement allows the jaws of theclip applier to be opened and closed, as many times as needed, toposition the clip applier in a patient without cycling a clip. Once theclip applier is suitably positioned in the patient, the clip feedingsystem can be re-activated such that the clip feeding system and the jawdrive system can be used to co-operatively apply clips to the patienttissue. In various embodiments, the clip applier includes an actuatorand/or control in communication with the control system of the clipapplier that deactivates the clip feeding system when actuated. Incertain embodiments, the actuator is re-actuated to re-activate the clipfeeding system or the clip applier comprises a separate actuator tore-activate the clip applier.

Further to the above, the jaws of a clip applier can be used to graspand/or dissect the patient's tissue. In such instances, the jaws can berepeatedly opened and closed. Deactivating the clip feeding system, asdescribed above, can facilitate an end effector being used in thismanner. In addition to or in lieu of the above, a clip applier can havea grasping and/or dissecting mode. In such a mode, or modes, thecontroller of the clip applier can move the jaws outside of their normalclosing and opening strokes. In a grasping mode, for instance, the jawscan be moved closer together than their fully-crimped, or fully-fired,position. In such a position, the jaws can be used to grasp very smallobjects, such as a suturing needle, for example. In a dissecting mode,for instance, the jaws can be moved further apart than their open, orready-to-fire, position. In such a position, the jaws can be used tospread open an otomy in the patient tissue. Similar to the above, theclip applier can include one or more actuators and/or controls which canbe used to place the clip applier in a grasping and/or dissecting mode,or modes by the clinician.

Notably, further to the above, the loads, or forces, experienced by thejaws of the clip applier, and/or patterns of forces experienced by thejaws of the clip applier, are detectably different by one or more straingauges and/or load cells, for example. For instance, the jaws of theclip applier may experience very little loading throughout the closingstroke of the jaws, or at least until the end of the closing stroke,when a clip is not positioned between the jaws and the jaws are beingused for grasping. The controller of the clip applier can identify sucha force pattern and automatically enter into the grasping mode. Asimilar pattern can occur when the jaws of the clip applier are beingused to dissect the tissue, except that the force suddenly increases asthe jaws are being opened. The controller of the clip applier canidentify such a force pattern and automatically enter into thedissecting mode. The clip applier can have an override feature which,when actuated by the clinician, can place the clip applier back into itsclip firing mode.

As described above, the control system of the clip applier ispre-programmed, or programmed prior to being used by the clinician, tomove the jaws of the clip applier to pre-determined positions. Invarious instances, the control system comprises an interface configuredto permit the clinician to set, or program, positions for the jaws. Suchan interface can include a control screen and/or actuators incommunication with the clip applier control system, for example. Thecontrol system comprises a memory, such as a solid state memory, forexample, configured to store these settings such that the jaws can beautomatically moved to these positions when directed to do so by theclinician. In at least one instance, the clip applier comprises a firstposition control and a second position control, but could include anysuitable number of position controls. For each position control, theclinician can program a specific position or configuration for the jawswhen the position control is actuated. Such positions can include a lessthan fully-open position and a less than fully-closed position, forexample.

Further to the above, the initial testing of a clip applier on amanufacturing line generates the expected load curve needed to fire aclip in that specific clip applier. The load curve can be used to form aset of thresholds that the device is expected to operate within, such asthe set points discussed above, for example. The motor current ismeasured as an indicator of load while closing the jaws while the motorvoltage is an indicator of motor speed. If, during use, the load on themotor exceeds the expected threshold (indicating higher loads and/orthicker tissue, for example), the closed loop nature of the systemallows the control algorithm stored in the memory of the motorcontroller to adjust the current supplied to the motor. These changes,however, are on-the-fly changes. They do not evaluate the loadsexperienced during other firings in that instrument, or in otherinstruments. That said, such data can be used to adapt the controlprogram of the clip applier. Such adjustments can comprise adjusting themotor voltage to slow down the advancement rate of the crimping driveand/or change the final stroke position of the crimping drive, forexample.

Situational awareness can be used to adjust operations of the clipapplier. Situational awareness is the ability of a surgical system todetermine or infer information related to a surgical procedure from datareceived from databases and/or instruments. The information can includethe type of procedure being undertaken, the type of tissue beingoperated on, or the body cavity that is the subject of the procedure.With the contextual information related to the surgical procedure, thesurgical system can, for example, improve the manner in which itcontrols an instrument and provide suggestions to the surgeon during thecourse of the surgical procedure. In various instances, the control ofthe surgical instrument can be adjusted without requiring input from theuser of the surgical instrument.

The clip appliers described herein, when used in conjunction with thesurgical hub and situational awareness modules as described hereinand/or incorporated by reference herein, can be utilized to detectdiseased tissue and/or detect tissue quality. For example, the clipappliers disclosed herein can detect an atherosclerosis (e.g., hardeningof the arteries) or aneurysms (e.g., weak artery walls), as well asdetect the presence of another clip, staple, or artificial objectcaptured between the jaws of the clip applier.

More specifically, a surgical hub or system, can detect the risk of apotential atherosclerosis (hardening of the arteries) by surveyingcontextual cues (e.g., pre-determined patient information and/or patientinformation gathered by the surgical system during the procedure, forexample) stored in the surgical hub that are indicative of such acondition, such as, high blood pressure, high cholesterol (especiallyLDL cholesterol), and co-morbidites (e.g., obesity and diabetes, forexample). If such conditions are detected, the surgical hub can directthe clip applier being used to respond in a specific manner. The firstaction to the contextual cues can include slowing down the jaw actuationrate, lowering the max torque and clamp load thresholds for non-firingoperations (e.g., opening and closing the jaws of the clip applierwithout a clip present, for example) and/or decrease the max stroke of acam member or crimping drive being used to form the clip, for example.Further contextual cues can be monitored by the surgical system and asecond action can be taken by the surgical system in response to themonitored contextual cues, as discussed in greater detail below,

Further to the above, the surgical system can monitor a contextual cuesuch as the force required to crimp the clip. For example, the irregularforce peaks outside of the anticipated forming events and associatedslopes can be detected by the surgical system and the surgical systemcan direct the clip applier to perform a second action, Morespecifically, when irregular force peaks are detected, the motor can bestopped and the force on the jaws can be monitored to monitor the tissuecreep. Further, if the tissue does not relax (e.g., the tissue creep isabnormal) then something irregular may be in between the jaws. Thesurgical system can then indicate a fault condition and request feedbackfrom the user to open the jaws of the clip applier to preventunintentionally clamping the unknown object. Further still, if tissuerelaxation (e.g., tissue creep) is detected but is outside of thepredefined anticipated range, the surgical system can adjust theadvancement rate of the crimping/closure drive with additional set stoppoints for further monitoring and move the jaws at a slower crimpingrate. In other words, the surgical system can pause the closing of thejaws to monitor the tissue creep and then determine how to proceed basedon the tissue creep detected, for example.

Further to the above, the surgical system can monitor a contextual cuesuch as the load on the crimping drive shaft of the clip applier, forexample. The crimping drive shaft can be outfitted with a strain gaugein order to determine the forces within the crimping drive shaft whenthe clip applier crimps a clip. Thus, the strain gauge can be used todetermine the forces being applied to the tissue by the clip applierjaws. The clip applier can be used in conjunction with a surgicalsystem, as discussed above, including a surgical grasper, for example.The surgical grasper is used to hold the target tissue and can stretchor relax the tissue depending on the load detected within the crimpingdrive shaft. For example, if the loading of the crimping drive shaftapproaches a threshold value this indicates that the tissue beinggrasped or clipped is too thick for a clip to be crimped around thetissue, the grasper of the surgical system will automatically move in anattempt to relieve the forces on the crimping drive shaft. Morespecifically, the grasper can move to stretch the tissue to thin thetissue between the jaws of the clip applier so that the clip can beproperly crimped around the tissue, for example. If automatic reliefefforts do not relieve the load, the actuation of the jaws of the clipapplier via the crimping drive shaft, for example) can be slowed orstopped by the surgical system.

Further to the above, the surgical hub can detect an aneurysm (weakartery wall strength) by surveying contextual cues (e.g., pre-determinedpatient information and/or patient information gathered by the surgicalsystem during the procedure, for example) stored in the surgical hubthat are indicative of such a condition. For example, a vision system ofthe surgical system including one or more cameras can detect a bulge orchange in artery thickness in a clamping location relative to adjacentareas. In addition to or in lieu of the above, the impedance of tissuecan be monitored to determine if a fatty deposit within the artery wallexists, which may be a sign of a weak artery wall. Also, the clipapplier jaw loading can be monitored to determine if there is a suddencompliance of the tissue indicative of a weak artery wall. In suchinstances, the force required to crimp a clip around the tissue is lessthan expected. A action to the contextual cues can be taken in responseto the monitored parameters, which can include slowing down the jawactuation rate, lowering the max torque and clamp load thresholds fornon-firing operations, and/or decrease the max stroke of a cam member orcrimping drive that drives clip formation, for example.

Further to the above, the surgical system can initiate an inquiry to thesurgical hub databases for a list of known contributing factors for ananeurysm that the patient may exhibit prior to or during the surgicalprocedure. This information can be used by the surgical system todetermine if the cause of the irregularity during tissue clampingrequires a greater/different response. For example, the knowncontributing factors inquired by the surgical system may include highblood pressure, smoking, obesity, family history of atherosclerosis,bacterial activity, and/or polyarteritis nodosa (e.g., inflammation ofthe small and medium arteries)—which, if present, can cause thecontroller of the hub to assume that an aneurysm is present.

Further to the above, the surgical system can monitor the contextualcues to identify a potential issue such as a weakened artery wall, forexample. if the surgeon pauses to inspect the surgical site after thedetected weakness is presented to the user, the clip applier canautomatically slow the crimping rate of the clip. In other words, thesurgical system assumes that a hesitation by the surgeon indicates thatthe surgeon is being cautious due to the contextual cue presented; thus,the surgical system automatically responds by slowing down the crimpingrate of the clip to prevent unintended tissue damage if there is in factan artery wall weakness present.

Further to the above, the surgical hub can detect the presence ofanother clip, staple, or object within the jaws of the clip applier bysurveying contextual cues stored in the surgical hub that are indicativeof such a condition.

For instance, if a previous procedure used clips in the relevant bodycavity, the controller can assume that high force stresses and/orstrains are the result of a previous clip being captured in the endeffector. The contextual cues to monitor to determine if an undesiredobject is between the jaws when clamping can include the forces on theclip during clip formation. If the forces depict a spike with highmagnitude and very steep slope during clip formation, at a time aftertip contact, or during leg forming, this can be indicative of anirregular object within the clip applier jaws. Further, visual cues fromthe vision system, described herein, can indicate to the use that anirregular object, such as a staple or clip already positioned in thesurgical site may be in between the jaws of the clip applier. Thisinformation can be fed back to the surgical hub, and/or the clip applierdirectly, to direct the clip applier to perform specific actions inresponse to the detected information. For example, the clip applier jawscan be stopped and a visual alert can be provided to the clinician, thefinal stroke distance to form the clip can be shortened such that thefinal crimped clip is not fully crimped to avoid shearing the irregularobject, and/or the jaws can be closed at a very slow rate to minimizethe damage to the irregular object and surrounding tissue.

FIG. 502 is a logic diagram of a control system 75000 for use with anyof the various clip appliers described herein. The control system 75000comprises a control circuit. The control circuit includes amicrocontroller 75040 comprising a processor 75020 and a memory 75030.One or more sensors, such as sensor 75080, sensor 75090, sensor 71502,and sensor array 71940, for example, provide real time feedback to theprocessor 75020. The control system 75000 further comprises a motordriver 75050 configured to control an electric motor 75010 and atracking system 75060 configured to determine the position of one ormore longitudinally movable components in the clip applier, such asfiring member 70165 (FIG. 309 ), crimping drive 70180 (FIG. 312 ),feeder member 70630 (FIG. 336 ), firing member 70640 (FIG. 336 ), andclosure tube 70620 (FIG. 336 ), for example. The tracking system 75060is also configured to determine the position of one or more rotationalcomponents in the clip applier, such as the rotatable clip magazine70650 (FIG. 335 ), for example. The tracking system 75060 providesposition information to the processor 75020, which can be programmed orconfigured to, among other things, determine the position of therotatable clip magazine 70650 (FIG. 335 ), determine the position of thefiring member, feeder member, closure tube and/or crimping drive, aswell as determine the orientation of the jaws of the clip applier. Themotor driver 75050 may be an A3941 available from Allegro Microsystems,Inc., for example; however, other motor drivers may be readilysubstituted for use in the tracking system 75060. A detailed descriptionof an absolute positioning system is described in U.S. PatentApplication Publication No. 2017/0296213, entitled SYSTEMS AND METHODSFOR CONTROLLING A SURGICAL STAPLING AND CUTTING INSTRUMENT, the entiredisclosure of which is hereby incorporated herein by reference.

The microcontroller 75040 may be any single core or multicore processorsuch as those known under the trade name ARM Cortex by TexasInstruments, for example. In at least one instance, the microcontroller75040 is a LM4F230H5QR ARM Cortex-M4F Processor Core, available fromTexas Instruments, for example, comprising on-chip memory of 256 KBsingle-cycle flash memory, or other non-volatile memory, up to 40 MHz, aprefetch buffer to improve performance above 40 MHz, a 32 KBsingle-cycle serial random access memory (SRAM), internal read-onlymemory (ROM) loaded with StellarisWare® software, 2 KB electricallyerasable programmable read-only memory (EEPROM), one or more pulse widthmodulation (PWM) modules and/or frequency modulation (FM) modules, oneor more quadrature encoder inputs (QEI) analog, one or more 12-bitAnalog-to-Digital Converters (ADC) with 12 analog input channels, forexample, details of which are available from the product datasheet.

In various instances, the microcontroller 75040 comprises a safetycontroller comprising two controller-based families such as TMS570 andRM4x known under the trade name Hercules ARM Cortex R4, also by TexasInstruments. The safety controller may be configured specifically forIEC 61508 and ISO 26262 safety critical applications, among others, toprovide advanced integrated safety features while delivering scalableperformance, connectivity, and memory options.

The microcontroller 75040 is programmed to perform various functionssuch as precisely controlling the speed and/or position of the firingmember, feeder member, crimping drive or closure tube of any of the clipappliers disclosed herein, for example. The microcontroller 75040 isalso programmed to precisely control the rotational speed and positionof the end effector of the clip applier and the articulation speed andposition of the end effector of the clip applier. In various instances,the microcontroller 75040 computes a response in the software of themicrocontroller 75040. The computed response is compared to a measuredresponse of the actual system to obtain an “observed” response, which isused for actual feedback decisions. The observed response is afavorable, tuned, value that balances the smooth, continuous nature ofthe simulated response with the measured response, which can detectoutside influences on the system.

The motor 75010 is controlled by the motor driver 75050. In variousforms, the motor 75010 is a DC brushed driving motor having a maximumrotational speed of approximately 25,000 RPM, for example. In otherarrangements, the motor 75010 includes a brushless motor, a cordlessmotor, a synchronous motor, a stepper motor, or any other suitableelectric motor. The motor driver 75050 may comprise an H-bridge drivercomprising field-effect transistors (FETs), for example. The motordriver 75050 may be an A3941 available from Allegro Microsystems, Inc.,for example. The A3941 motor driver 75050 is a full-bridge controllerfor use with external N-channel power metal oxide semiconductor fieldeffect transistors (MOSFETs) specifically designed for inductive loads,such as brush DC motors. In various instances, the motor driver 75050comprises a unique charge pump regulator provides full (>10 V) gatedrive for battery voltages down to 7 V and allows the A3941 motor driver75050 to operate with a reduced gate drive, down to 5.5 V. A bootstrapcapacitor may be employed to provide the above-battery supply voltagerequired for N-channel MOSFETs. An internal charge pump for thehigh-side drive allows DC (100% duty cycle) operation. The full bridgecan be driven in fast or slow decay modes using diode or synchronousrectification. In the slow decay mode, current recirculation can bethrough the high-side or the lowside FETs. The power FETs are protectedfrom shoot-through by resistor adjustable dead time. Integrateddiagnostics provide indication of undervoltage, overtemperature, andpower bridge faults, and can be configured to protect the power MOSFETsunder most short circuit conditions. Other motor drivers may be readilysubstituted.

The tracking system 75060 comprises a controlled motor drive circuitarrangement comprising one or more position sensors, such as the sensor75080, sensor 75090, sensor 71502, and sensory array 71940, for example.The position sensors for an absolute positioning system provide a uniqueposition signal corresponding to the location of a displacement member.As used herein, the term displacement member is used generically torefer to any movable member of any of the clip appliers disclosedherein. In various instances, the displacement member may be coupled toany position sensor suitable for measuring linear displacement orrotational displacement. Linear displacement sensors may include contactor non-contact displacement sensors. The displacement sensors maycomprise linear variable differential transformers (LVDT), differentialvariable reluctance transducers (DVRT), a slide potentiometer, amagnetic sensing system comprising a movable magnet and a series oflinearly arranged Hall Effect sensors similar to the arrangementillustrated in FIG. 362 , a magnetic sensing system comprising a fixedmagnet and a series of movable linearly arranged Hall Effect sensorssimilar to the arrangement illustrated in FIGS. 369 and 370 , an opticalsensing system comprising a movable light source and a series oflinearly arranged photo diodes or photo detectors, or an optical sensingsystem comprising a fixed light source and a series of movable linearlyarranged photo diodes or photo detectors, or any combination thereof.

The position sensors 75080, 75090, 71502, and 71940 for example, maycomprise any number of magnetic sensing elements, such as, for example,magnetic sensors classified according to whether they measure the totalmagnetic field or the vector components of the magnetic field. Thetechniques used to produce both types of magnetic sensors encompass manyaspects of physics and electronics. The technologies used for magneticfield sensing include search coil, fluxgate, optically pumped, nuclearprecession, SQUID, Hall-Effect, anisotropic magnetoresistance, giantmagnetoresistance, magnetic tunnel junctions, giant magnetoimpedance,magnetostrictive/piezoelectric composites, magnetodiode,magnetotransistor, fiber optic, magnetooptic, and microelectromechanicalsystems-based magnetic sensors, among others.

In various instances, one or more of the position sensors of thetracking system 75060 comprise a magnetic rotary absolute positioningsystem. Such position sensors may be implemented as an AS5055EQFTsingle-chip magnetic rotary position sensor available from AustriaMicrosystems, AG and can be interfaced with the controller 75040 toprovide an absolute positioning system. In certain instances, a positionsensor comprises a low-voltage and low-power component and includes fourHall-Effect elements in an area of the position sensor that is locatedadjacent a magnet. A high resolution ADC and a smart power managementcontroller are also provided on the chip. A CORDIC processor (forCoordinate Rotation Digital Computer), also known as the digit-by-digitmethod and Volder's algorithm, is provided to implement a simple andefficient algorithm to calculate hyperbolic and trigonometric functionsthat require only addition, subtraction, bitshift, and table lookupoperations. The angle position, alarm bits, and magnetic fieldinformation are transmitted over a standard serial communicationinterface such as an SPI interface to the controller 75040. The positionsensors can provide 12 or 14 bits of resolution, for example. Theposition sensors can be an AS5055 chip provided in a small QFN 16-pin4×4×0.85 mm package, for example.

The tracking system 75060 may comprise and/or be programmed to implementa feedback controller, such as a PID, state feedback, and adaptivecontroller. A power source converts the signal from the feedbackcontroller into a physical input to the system, in this case voltage.Other examples include pulse width modulation (PWM) and/or frequencymodulation (FM) of the voltage, current, and force. Other sensor(s) maybe provided to measure physical parameters of the physical system inaddition to position. In various instances, the other sensor(s) caninclude sensor arrangements such as those described in U.S. Pat. No.9,345,481, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM,which is hereby incorporated herein by reference in its entirety; U.S.Patent Application Publication No. 2014/0263552, entitled STAPLECARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, which is hereby incorporatedherein by reference in its entirety; and U.S. patent application Ser.No. 15/628,175, entitled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTORVELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT, which is herebyincorporated herein by reference in its entirety. In a digital signalprocessing system, absolute positioning system is coupled to a digitaldata acquisition system where the output of the absolute positioningsystem will have finite resolution and sampling frequency. The absolutepositioning system may comprise a compare and combine circuit to combinea computed response with a measured response using algorithms such asweighted average and theoretical control loop that drives the computedresponse towards the measured response. The computed response of thephysical system takes into account properties like mass, inertial,viscous friction, inductance resistance, etc., to predict what thestates and outputs of the physical system will be by knowing the input.

The absolute positioning system provides an absolute position of thedisplacement member upon power up of the instrument without retractingor advancing the displacement member to a reset (zero or home) positionas may be required with conventional rotary encoders that merely countthe number of steps forwards or backwards that the motor 75010 has takento infer the position of a device actuator, a firing member, a feederdrive, a crimping drive, a closure tube, and the like.

A sensor 75080 comprising a strain gauge or a micro-strain gauge, forexample, is configured to measure one or more parameters of the endeffector of the clip applier, such as, for example, the strainexperienced by the jaws during a crimping operation. In one embodiment,the sensor 75080 can comprise the strain gauges 71720 and 71730 (FIG.367 ) discussed in greater detail above, for example. The measuredstrain is converted to a digital signal and provided to the processor75020. In addition to or in lieu of the sensor 75080, a sensor 75090comprising a load sensor, for example, can measure the closure forceapplied by the closure drive system to the jaws of the clip applier. Invarious instances, a current sensor 75070 can be employed to measure thecurrent drawn by the motor 75010. The force required to clamp the firstand second jaws to crimp a clip can correspond to the current drawn bythe motor 75010, for example. The measured force is converted to adigital signal and provided to the processor 75020. A magnetic fieldsensor can be employed to measure the thickness of the captured tissue.The measurement of the magnetic field sensor can also be converted to adigital signal and provided to the processor 75020.

The measurements of the tissue compression, the tissue thickness, and/orthe force required to close the end effector and crimp a clip aroundtissue as measured by the sensors can be used by the controller 75040 tocharacterize the position and/or speed of the movable member beingtracked. In at least one instance, the memory 75030 may store atechnique, an equation, and/or a look-up table which can be employed bythe controller 75040 in the assessment. In various instances, thecontroller 75040 can provide the user of the clip applier with a choiceas to the manner in which the clip applier should be operated. To thisend, a display 75044 can display a variety of operating conditions ofthe clip applier and can include touch screen functionality for datainput. Moreover, information displayed on the display 75044 may beoverlaid with images acquired via the imaging modules of one or moreendoscopes and/or one or more additional surgical instruments usedduring the surgical procedure.

As discussed above, the clip appliers disclosed herein may comprisecontrol systems. Each of the control systems can comprise a circuitboard having one or more processors and/or memory devices. Among otherthings, the control systems are configured to store sensor data, forexample. They are also configured to store data which identifies thetype of clip applier attached to a handle or housing, such as handle 700(FIG. 303 ), for example. More specifically, the type of clip appliercan be identified when attached to the handle or housing by the sensorsand the sensor data can be stored in the control system. Moreover, theyare also configured to store data including whether or not the clipapplier has been previously used and/or how many clips have been ejectedfrom the clip magazine or clip cartridge of the clip applier duringoperation. This information can be obtained by the control system toassess whether or not the clip applier is suitable for use and/or hasbeen used less than a predetermined number of times, for example.

A surgical instrument, such as a grasper, for example, can comprise ahandle, a shaft extending from the handle, and an end effector extendingfrom the shaft. In various instances, the end effector comprises a firstjaw and a second jaw, wherein one or both of the jaws are movablerelative to the other to grasp the tissue of a patient. That said, anend effector of a surgical instrument can comprise any suitablearrangement and can perform any suitable function. For instance, an endeffector can comprise first and second jaws configured to dissect orseparate the tissue of a patient. Also, for instance, an end effectorcan be configured to suture and/or clip the tissue of a patient. Invarious instances, the end effector and/or shaft of the surgicalinstrument are configured to be inserted into a patient through atrocar, or cannula, and can have any suitable diameter, such asapproximately 5 mm, 8 mm, and/or 12 mm, for example. U.S. patentapplication Ser. No. 11/013,924, entitled TROCAR SEAL ASSEMBLY, now U.S.Pat. No. 7,371,227, is incorporated by reference in its entirety. Theshaft can define a longitudinal axis and at least a portion of the endeffector can be rotatable about the longitudinal axis. Moreover, thesurgical instrument can further comprise an articulation joint which canpermit at least a portion of the end effector to be articulated relativeto the shaft. In use, a clinician can rotate and/or articulate the endeffector in order to maneuver the end effector within the patient.

A surgical instrument system is depicted in FIG. 503 . The surgicalinstrument system comprises a handle assembly 1000 which is selectivelyusable with a shaft assembly 2000, a shaft assembly 3000, a shaftassembly 4000, a shaft assembly 5000, and/or any other suitable shaftassembly. The shaft assembly 2000 is attached to the handle assembly1000 in FIG. 504 and the shaft assembly 4000 is attached to the handleassembly 1000 in FIG. 548 . The shaft assembly 2000 comprises a proximalportion 2100, an elongate shaft 2200 extending from the proximal portion2100, a distal attachment portion 2400, and an articulation joint 2300rotatably connecting the distal attachment portion 2400 to the elongateshaft 2200. The shaft assembly 2000 further comprises a replaceable endeffector assembly 7000 attached to the distal attachment portion 2400.The replaceable end effector assembly 7000 comprises a jaw assembly 7100configured to be opened and closed to clamp and/or manipulate the tissueof a patient. In use, the end effector assembly 7000 can be articulatedabout the articulation joint 2300 and/or rotated relative to the distalattachment portion 2400 about a longitudinal axis to better position thejaw assembly 7100 within the patient, as described in greater detailfurther below.

Referring again to FIG. 503 , the handle assembly 1000 comprises, amongother things, a drive module 1100. As described in greater detail below,the drive module 1100 comprises a distal mounting interface whichpermits a clinician to selectively attach one of the shaft assemblies2000, 3000, 4000, and 5000, for example, to the drive module 1100. Thus,each of the shaft assemblies 2000, 3000, 4000, and 5000 comprises anidentical, or an at least similar, proximal mounting interface which isconfigured to engage the distal mounting interface of the drive module1100. As also described in greater detail below, the mounting interfaceof the drive module 1100 mechanically secures and electrically couplesthe selected shaft assembly to the drive module 1100. The drive module1100 further comprises at least one electric motor, one or more controlsand/or displays, and a controller configured to operate the electricmotor—the rotational output of which is transmitted to a drive system ofthe shaft assembly attached to the drive module 1100. Moreover, thedrive module 1100 is usable with one ore more power modules, such aspower modules 1200 and 1300, for example, which are operably attachableto the drive module 1100 to supply power thereto.

Further to the above, referring again to FIGS. 503 and 504 , the handledrive module 1100 comprises a housing 1110, a first module connector1120, and a second module connector 1120′. The power module 1200comprises a housing 1210, a connector 1220, one or more release latches1250, and one or more batteries 1230. The connector 1220 is configuredto be engaged with the first module connector 1120 of the drive module1100 in order to attach the power module 1200 to the drive module 1100.The connector 1220 comprises one or more latches 1240 which mechanicallycouple and fixedly secure the housing 1210 of the power module 1200 tothe housing 1110 of the drive module 1100. The latches 1240 are movableinto disengaged positions when the release latches 1250 are depressed sothat the power module 1200 can be detached from the drive module 1100.The connector 1220 also comprises one or more electrical contacts whichplace the batteries 1230, and/or an electrical circuit including thebatteries 1230, in electrical communication with an electrical circuitin the drive module 1100.

Further to the above, referring again to FIGS. 503 and 504 , the powermodule 1300 comprises a housing 1310, a connector 1320, one or morerelease latches 1350, and one or more batteries 1330 (FIG. 550 ). Theconnector 1320 is configured to be engaged with the second moduleconnector 1120′ of the drive module 1100 to attach the power module 1300to the drive module 1100. The connector 1320 comprises one or morelatches 1340 which mechanically couple and fixedly secure the housing1310 of the power module 1300 to the housing 1110 of the drive module1100. The latches 1340 are movable into disengaged positions when therelease latches 1350 are depressed so that the power module 1300 can bedetached from the drive module 1100. The connector 1320 also comprisesone or more electrical contacts which place the batteries 1330 of thepower module 1300, and/or an electrical power circuit including thebatteries 1330, in electrical communication with an electrical powercircuit in the drive module 1100.

Further to the above, the power module 1200, when attached to the drivemodule 1100, comprises a pistol grip which can allow a clinician to holdthe handle 1000 in a manner which places the drive module 1100 on top ofthe clinician's hand. The power module 1300, when attached to the drivemodule 1100, comprises an end grip which allows a clinician to hold thehandle 1000 like a wand. The power module 1200 is longer than the powermodule 1300, although the power modules 1200 and 1300 can comprise anysuitable length. The power module 1200 has more battery cells than thepower module 1300 and can suitably accommodate these additional batterycells owing to its length. In various instances, the power module 1200can provide more power to the drive module 1100 than the power module1300 while, in some instances, the power module 1200 can provide powerfor a longer period of time. In some instances, the housing 1110 of thedrive module 1100 comprises keys, and/or any other suitable features,which prevent the power module 1200 from being connected to the secondmodule connector 1120′ and, similarly, prevent the power module 1300from being connected to the first module connector 1120. Such anarrangement can assure that the longer power module 1200 is used in thepistol grip arrangement and that the shorter power module 1300 is usedin the wand grip arrangement. In alternative embodiments, the powermodule 1200 and the power module 1300 can be selectively coupled to thedrive module 1100 at either the first module connector 1120 or thesecond module connector 1120′. Such embodiments provide a clinician withmore options to customize the handle 1000 in a manner suitable to them.

In various instances, further to the above, only one of the powermodules 1200 and 1300 is coupled to the drive module 1100 at a time. Incertain instances, the power module 1200 can be in the way when theshaft assembly 4000, for example, is attached to the drive module 1100.Alternatively, both of the power modules 1200 and 1300 can be operablycoupled to the drive module 1100 at the same time. In such instances,the drive module 1100 can have access to power provided by both of thepower modules 1200 and 1300. Moreover, a clinician can switch between apistol grip and a wand grip when both of the power modules 1200 and 1300are attached to the drive module 1100. Moreover, such an arrangementallows the power module 1300 to act as a counterbalance to a shaftassembly, such as shaft assemblies 2000, 3000, 4000, or 5000, forexample, attached to the drive module 1100.

Referring to FIGS. 509 and 510 , the handle drive module 1100 furthercomprises a frame 1500, a motor assembly 1600, a drive system 1700operably engaged with the motor assembly 1600, and a control system1800. The frame 1500 comprises an elongate shaft that extends throughthe motor assembly 1600. The elongate shaft comprises a distal end 1510and electrical contacts, or sockets, 1520 defined in the distal end1510. The electrical contacts 1520 are in electrical communication withthe control system 1800 of the drive module 1100 via one or moreelectrical circuits and are configured to convey signals and/or powerbetween the control system 1800 and the shaft assembly, such as theshaft assembly 2000, 3000, 4000, or 5000, for example, attached to thedrive module 1100. The control system 1800 comprises a printed circuitboard (PCB) 1810, at least one microprocessor 1820, and at least onememory device 1830. The board 1810 can be rigid and/or flexible and cancomprise any suitable number of layers. The microprocessor 1820 and thememory device 1830 are part of a control circuit defined on the board1810 which controls the operation of the motor assembly 1600, asdescribed in greater detail below.

Referring to FIGS. 514 and 515 , the motor assembly 1600 comprises anelectric motor 1610 including a housing 1620, a drive shaft 1630, and agear reduction system. The electric motor 1610 further comprises astator including windings 1640 and a rotor including magnetic elements1650. The stator windings 1640 are supported in the housing 1620 and therotor magnetic elements 1650 are mounted to the drive shaft 1630. Whenthe stator windings 1640 are energized with an electric currentcontrolled by the control system 1800, the drive shaft 1630 is rotatedabout a longitudinal axis. The drive shaft 1630 is operably engaged witha first planetary gear system 1660 which includes a central sun gear andseveral planetary gears operably intermeshed with the sun gear. The sungear of the first planetary gear system 1660 is fixedly mounted to thedrive shaft 1630 such that it rotates with the drive shaft 1630. Theplanetary gears of the first planetary gear system 1660 are rotatablymounted to the sun gear of a second planetary gear system 1670 and,also, intermeshed with a geared or splined inner surface 1625 of themotor housing 1620. As a result of the above, the rotation of the firstsun gear rotates the first planetary gears which rotate the second sungear. Similar to the above, the second planetary gear system 1670further comprises planetary gears 1665 (FIG. 515 ) which drive a thirdplanetary gear system and, ultimately, the drive shaft 1710. Theplanetary gear systems 1660, 1670, and 1680 co-operate to gear down thespeed applied to the drive shaft 1710 by the motor shaft 1620. Variousalternative embodiments are envisioned without a speed reduction system.Such embodiments are suitable when it is desirable to drive the endeffector functions quickly. Notably, the drive shaft 1630 comprises anaperture, or hollow core, extending therethrough through which wiresand/or electrical circuits can extend.

The control system 1800 is in communication with the motor assembly 1600and the electrical power circuit of the drive module 1100. The controlsystem 1800 is configured to control the power delivered to the motorassembly 1600 from the electrical power circuit. The electrical powercircuit is configured to supply a constant, or at least nearly constant,direct current (DC) voltage. In at least one instance, the electricalpower circuit supplies 3 VDC to the control system 1800. The controlsystem 1800 comprises a pulse width modulation (PWM) circuit which isconfigured to deliver voltage pulses to the motor assembly 1600. Theduration or width of the voltage pulses, and/or the duration or widthbetween the voltage pulses, supplied by the PWM circuit can becontrolled in order to control the power applied to the motor assembly1600. By controlling the power applied to the motor assembly 1600, thePWM circuit can control the speed of the output shaft of the motorassembly 1600. In addition to or in lieu of a PWM circuit, the controlsystem 1800 can include a frequency modulation (FM) circuit. Asdiscussed in greater detail below, the control system 1800 is operablein more than one operating mode and, depending on the operating modebeing used, the control system 1800 can operate the motor assembly 1600at a speed, or a range of speeds, which is determined to be appropriatefor that operating mode.

Further to the above, referring again to FIGS. 509 and 510 , the drivesystem 1700 comprises a rotatable shaft 1710 comprising a splined distalend 1720 and a longitudinal aperture 1730 defined therein. The rotatableshaft 1710 is operably mounted to the output shaft of the motor assembly1600 such that the rotatable shaft 1710 rotates with the motor outputshaft. The handle frame 1510 extends through the longitudinal aperture1730 and rotatably supports the rotatable shaft 1710. As a result, thehandle frame 1510 serves as a bearing for the rotatable shaft 1710. Thehandle frame 1510 and the rotatable shaft 1710 extend distally from amounting interface 1130 of the drive module 1110 and are coupled withcorresponding components on the shaft assembly 2000 when the shaftassembly 2000 is assembled to the drive module 1100. Referring primarilyto FIGS. 505-508 , the shaft assembly 2000 further comprises a frame2500 and a drive system 2700. The frame 2500 comprises a longitudinalshaft 2510 extending through the shaft assembly 2000 and a plurality ofelectrical contacts, or pins, 2520 extending proximally from the shaft2510. When the shaft assembly 2000 is attached to the drive module 1100,the electrical contacts 2520 on the shaft frame 2510 engage theelectrical contacts 1520 on the handle frame 1510 and create electricalpathways therebetween.

Similar to the above, the drive system 2700 comprises a rotatable driveshaft 2710 which is operably coupled to the rotatable drive shaft 1710of the handle 1000 when the shaft assembly 2000 is assembled to thedrive module 1100 such that the drive shaft 2710 rotates with the driveshaft 1710. To this end, the drive shaft 2710 comprises a splinedproximal end 2720 which mates with the splined distal end 1720 of thedrive shaft 1710 such that the drive shafts 1710 and 2710 rotatetogether when the drive shaft 1710 is rotated by the motor assembly1600. Given the nature of the splined interconnection between the driveshafts 1710 and 2710 and the electrical interconnection between theframes 1510 and 2510, the shaft assembly 2000 is assembled to the handle1000 along a longitudinal axis; however, the operable interconnectionbetween the drive shafts 1710 and 2710 and the electricalinterconnection between the frames 1510 and 2510 can comprise anysuitable configuration which can allow a shaft assembly to be assembledto the handle 1000 in any suitable manner.

As discussed above, referring to FIGS. 505-510 , the mounting interface1130 of the drive module 1110 is configured to be coupled to acorresponding mounting interface on the shaft assemblies 2000, 3000,4000, and 5000, for example. For instance, the shaft assembly 2000comprises a mounting interface 2130 configured to be coupled to themounting interface 1130 of the drive module 1100. More specifically, theproximal portion 2100 of the shaft assembly 2000 comprises a housing2110 which defines the mounting interface 2130. Referring primarily toFIG. 510 , the drive module 1100 comprises latches 1140 which areconfigured to releasably hold the mounting interface 2130 of the shaftassembly 2000 against the mounting interface 1130 of the drive module1100. When the drive module 1100 and the shaft assembly 2000 are broughttogether along a longitudinal axis, as described above, the latches 1140contact the mounting interface 2130 and rotate outwardly into anunlocked position. Referring primarily to FIGS. 510, 512, and 513 , eachlatch 1140 comprises a lock end 1142 and a pivot portion 1144. The pivotportion 1144 of each latch 1140 is rotatably coupled to the housing 1110of the drive module 1100 and, when the latches 1140 are rotatedoutwardly, as mentioned above, the latches 1140 rotate about the pivotportions 1144. Notably, each latch 1140 further comprises a biasingspring 1146 configured to bias the latches 1140 inwardly into a lockedposition. Each biasing spring 1146 is compressed between a latch 1140and the housing 1110 of the drive module 1100 such that the biasingsprings 1146 apply biasing forces to the latches 1140; however, suchbiasing forces are overcome when the latches 1140 are rotated outwardlyinto their unlocked positions by the shaft assembly 2000. That said,when the latches 1140 rotate outwardly after contacting the mountinginterface 2130, the lock ends 1142 of the latches 1140 can enter intolatch windows 2140 defined in the mounting interface 2130. Once the lockends 1142 pass through the latch windows 2140, the springs 1146 can biasthe latches 1140 back into their locked positions. Each lock end 1142comprises a lock shoulder, or surface, which securely holds the shaftassembly 2000 to the drive module 1100.

Further to the above, the biasing springs 1146 hold the latches 1140 intheir locked positions. The distal ends 1142 are sized and configured toprevent, or at least inhibit, relative longitudinal movement, i.e.,translation along a longitudinal axis, between the shaft assembly 2000and the drive module 1100 when the latches 1140 are in their lockedpositions. Moreover, the latches 1140 and the latch windows 1240 aresized and configured to prevent relative lateral movement, i.e.,translation transverse to the longitudinal axis, between the shaftassembly 2000 and the drive module 1100. In addition, the latches 1140and the latch windows 2140 are sized and configured to prevent the shaftassembly 2000 from rotating relative to the drive module 1100. The drivemodule 1100 further comprises release actuators 1150 which, whendepressed by a clinician, move the latches 1140 from their lockedpositions into their unlocked positions. The drive module 1100 comprisesa first release actuator 1150 slideably mounted in an opening defined inthe first side of the handle housing 1110 and a second release actuator1150 slideably mounted in an opening defined in a second, or opposite,side of the handle housing 1110. Although the release actuators 1150 areactuatable separately, both release actuators 1150 typically need to bedepressed to completely unlock the shaft assembly 2000 from the drivemodule 1100 and allow the shaft assembly 2000 to be detached from thedrive module 1100. That said, it is possible that the shaft assembly2000 could be detached from the drive module 1100 by depressing only onerelease actuator 1150.

Once the shaft assembly 2000 has been secured to the handle 1000 and theend effector 7000, for example, has been assembled to the shaft 2000,the clinician can maneuver the handle 1000 to insert the end effector7000 into a patient. In at least one instance, the end effector 7000 isinserted into the patient through a trocar and then manipulated in orderto position the jaw assembly 7100 of the end effector assembly 7000relative to the patient's tissue. Oftentimes, the jaw assembly 7100 mustbe in its closed, or clamped, configuration in order to fit through thetrocar. Once through the trocar, the jaw assembly 7100 can be opened sothat the patient tissue fit between the jaws of the jaw assembly 7100.At such point, the jaw assembly 7100 can be returned to its closedconfiguration to clamp the patient tissue between the jaws. The clampingforce applied to the patient tissue by the jaw assembly 7100 issufficient to move or otherwise manipulate the tissue during a surgicalprocedure. Thereafter, the jaw assembly 7100 can be re-opened to releasethe patient tissue from the end effector 7000. This process can berepeated until it is desirable to remove the end effector 7000 from thepatient. At such point, the jaw assembly 7100 can be returned to itsclosed configuration and retracted through the trocar. Other surgicaltechniques are envisioned in which the end effector 7000 is insertedinto a patient through an open incision, or without the use of thetrocar. In any event, it is envisioned that the jaw assembly 7100 mayhave to be opened and closed several times throughout a surgicaltechnique.

Referring again to FIGS. 505-508 , the shaft assembly 2000 furthercomprises a clamping trigger system 2600 and a control system 2800. Theclamping trigger system 2600 comprises a clamping trigger 2610 rotatablyconnected to the proximal housing 2110 of the shaft assembly 2000. Asdiscussed below, the clamping trigger 2610 actuates the motor 1610 tooperate the jaw drive of the end effector 7000 when the clamping trigger2610 is actuated. The clamping trigger 2610 comprises an elongateportion which is graspable by the clinician while holding the handle1000. The clamping trigger 2610 further comprises a mounting portion2620 which is pivotably connected to a mounting portion 2120 of theproximal housing 2110 such that the clamping trigger 2610 is rotatableabout a fixed, or an at least substantially fixed, axis. The closuretrigger 2610 is rotatable between a distal position and a proximalposition, wherein the proximal position of the closure trigger 2610 iscloser to the pistol grip of the handle 1000 than the distal position.The closure trigger 2610 further comprises a tab 2615 extendingtherefrom which rotates within the proximal housing 2110. When theclosure trigger 2610 is in its distal position, the tab 2615 ispositioned above, but not in contact with, a switch 2115 mounted on theproximal housing 2110. The switch 2115 is part of an electrical circuitconfigured to detect the actuation of the closure trigger 2610 which isin an open condition the closure trigger 2610 is in its open position.When the closure trigger 2610 is moved into its proximal position, thetab 2615 comes into contact with the switch 2115 and closes theelectrical circuit. In various instances, the switch 2115 can comprise atoggle switch, for example, which is mechanically switched between openand closed states when contacted by the tab 2615 of the closure trigger2610. In certain instances, the switch 2115 can comprise a proximitysensor, for example, and/or any suitable type of sensor. In at least oneinstance, the switch 2115 comprises a Hall Effect sensor which candetect the amount in which the closure trigger 2610 has been rotatedand, based on the amount of rotation, control the speed in which themotor 1610 is operated. In such instances, larger rotations of theclosure trigger 2610 result in faster speeds of the motor 1610 whilesmaller rotations result in slower speeds, for example. In any event,the electrical circuit is in communication with the control system 2800of the shaft assembly 2000, which is discussed in greater detail below.

Further to the above, the control system 2800 of the shaft assembly 2000comprises a printed circuit board (PCB) 2810, at least onemicroprocessor 2820, and at least one memory device 2830. The board 2810can be rigid and/or flexible and can comprise any suitable number oflayers. The microprocessor 2820 and the memory device 2830 are part of acontrol circuit defined on the board 2810 which communicates with thecontrol system 1800 of the handle 1000. The shaft assembly 2000 furthercomprises a signal communication system 2900 and the handle 1000 furthercomprises a signal communication system 1900 which are configured toconvey data between the shaft control system 2800 and the handle controlsystem 1800. The signal communication system 2900 is configured totransmit data to the signal communication system 1900 utilizing anysuitable analog and/or digital components. In various instances, thecommunication systems 2900 and 1900 can communicate using a plurality ofdiscrete channels which allows the input gates of the microprocessor1820 to be directly controlled, at least in part, by the output gates ofthe microprocessor 2820. In some instances, the communication systems2900 and 1900 can utilize multiplexing. In at least one such instance,the control system 2900 includes a multiplexing device that sendsmultiple signals on a carrier channel at the same time in the form of asingle, complex signal to a multiplexing device of the control system1900 that recovers the separate signals from the complex signal.

The communication system 2900 comprises an electrical connector 2910mounted to the circuit board 2810. The electrical connector 2910comprises a connector body and a plurality of electrically-conductivecontacts mounted to the connector body. The electrically-conductivecontacts comprise male pins, for example, which are soldered toelectrical traces defined in the circuit board 2810. In other instances,the male pins can be in communication with circuit board traces throughzero-insertion-force (ZIF) sockets, for example. The communicationsystem 1900 comprises an electrical connector 1910 mounted to thecircuit board 1810. The electrical connector 1910 comprises a connectorbody and a plurality of electrically-conductive contacts mounted to theconnector body. The electrically-conductive contacts comprise femalepins, for example, which are soldered to electrical traces defined inthe circuit board 1810. In other instances, the female pins can be incommunication with circuit board traces through zero-insertion-force(ZIF) sockets, for example. When the shaft assembly 2000 is assembled tothe drive module 1100, the electrical connector 2910 is operably coupledto the electrical connector 1910 such that the electrical contacts formelectrical pathways therebetween. The above being said, the connectors1910 and 2910 can comprise any suitable electrical contacts. Moreover,the communication systems 1900 and 2900 can communicate with one anotherin any suitable manner. In various instances, the communication systems1900 and 2900 communicate wirelessly. In at least one such instance, thecommunication system 2900 comprises a wireless signal transmitter andthe communication system 1900 comprises a wireless signal receiver suchthat the shaft assembly 2000 can wirelessly communicate data to thehandle 1000. Likewise, the communication system 1900 can comprise awireless signal transmitter and the communication system 2900 cancomprise a wireless signal receiver such that the handle 1000 canwirelessly communicate data to the shaft assembly 2000.

As discussed above, the control system 1800 of the handle 1000 is incommunication with, and is configured to control, the electrical powercircuit of the handle 1000. The handle control system 1800 is alsopowered by the electrical power circuit of the handle 1000. The handlecommunication system 1900 is in signal communication with the handlecontrol system 1800 and is also powered by the electrical power circuitof the handle 1000. The handle communication system 1900 is powered bythe handle electrical power circuit via the handle control system 1800,but could be directly powered by the electrical power circuit. As alsodiscussed above, the handle communication system 1900 is in signalcommunication with the shaft communication system 2900. That said, theshaft communication system 2900 is also powered by the handle electricalpower circuit via the handle communication system 1900. To this end, theelectrical connectors 1910 and 2010 connect both one or more signalcircuits and one or more power circuits between the handle 1000 and theshaft assembly 2000. Moreover, the shaft communication system 2900 is insignal communication with the shaft control system 2800, as discussedabove, and is also configured to supply power to the shaft controlsystem 2800. Thus, the control systems 1800 and 2800 and thecommunication systems 1900 and 2900 are all powered by the electricalpower circuit of the handle 1000; however, alternative embodiments areenvisioned in which the shaft assembly 2000 comprises its own powersource, such as one or more batteries, for example, an and electricalpower circuit configured to supply power from the batteries to thehandle systems 2800 and 2900. In at least one such embodiment, thehandle control system 1800 and the handle communication system 1900 arepowered by the handle electrical power system and the shaft controlsystem 2800 and the handle communication system 2900 are powered by theshaft electrical power system.

Further to the above, the actuation of the clamping trigger 2610 isdetected by the shaft control system 2800 and communicated to the handlecontrol system 1800 via the communication systems 2900 and 1900. Uponreceiving a signal that the clamping trigger 2610 has been actuated, thehandle control system 1800 supplies power to the electric motor 1610 ofthe motor assembly 1600 to rotate the drive shaft 1710 of the handledrive system 1700, and the drive shaft 2710 of the shaft drive system2700, in a direction which closes the jaw assembly 7100 of the endeffector 7000. The mechanism for converting the rotation of the driveshaft 2710 to a closure motion of the jaw assembly 7100 is discussed ingreater detail below. So long as the clamping trigger 2610 is held inits actuated position, the electric motor 1610 will rotate the driveshaft 1710 until the jaw assembly 7100 reaches its fully-clampedposition. When the jaw assembly 7100 reaches its fully-clamped position,the handle control system 1800 cuts the electrical power to the electricmotor 1610. The handle control system 1800 can determine when the jawassembly 7100 has reached its fully-clamped position in any suitablemanner. For instance, the handle control system 1800 can comprise anencoder system which monitors the rotation of, and counts the rotationsof, the output shaft of the electric motor 1610 and, once the number ofrotations reaches a predetermined threshold, the handle control system1800 can discontinue supplying power to the electric motor 1610. In atleast one instance, the end effector assembly 7000 can comprise one ormore sensors configured to detect when the jaw assembly 7100 has reachedits fully-clamped position. In at least one such instance, the sensorsin the end effector 7000 are in signal communication with the handlecontrol system 1800 via electrical circuits extending through the shaftassembly 2000 which can include the electrical contacts 1520 and 2520,for example.

When the clamping trigger 2610 is rotated distally out of its proximalposition, the switch 2115 is opened which is detected by the shaftcontrol system 2800 and communicated to the handle control system 1800via the communication systems 2900 and 1900. Upon receiving a signalthat the clamping trigger 2610 has been moved out of its actuatedposition, the handle control system 1800 reverses the polarity of thevoltage differential being applied to the electric motor 1610 of themotor assembly 1600 to rotate the drive shaft 1710 of the handle drivesystem 1700, and the drive shaft 2710 of the shaft drive system 2700, inan opposite direction which, as a result, opens the jaw assembly 7100 ofthe end effector 7000. When the jaw assembly 7100 reaches its fully-openposition, the handle control system 1800 cuts the electrical power tothe electric motor 1610. The handle control system 1800 can determinewhen the jaw assembly 7100 has reached its fully-open position in anysuitable manner. For instance, the handle control system 1800 canutilize the encoder system and/or the one or more sensors describedabove to determine the configuration of the jaw assembly 7100. In viewof the above, the clinician needs to be mindful about holding theclamping trigger 2610 in its actuated position in order to maintain thejaw assembly 7100 in its clamped configuration as, otherwise, thecontrol system 1800 will open jaw assembly 7100. With this in mind, theshaft assembly 2000 further comprises an actuator latch 2630 configuredto releasably hold the clamping trigger 2610 in its actuated position toprevent the accidental opening of the jaw assembly 7100. The actuatorlatch 2630 can be manually released, or otherwise defeated, by theclinician to allow the clamping trigger 2610 to be rotated distally andopen the jaw assembly 7100.

The clamping trigger system 2600 further comprises a resilient biasingmember, such as a torsion spring, for example, configured to resist theclosure of the clamping trigger system 2600. The torsion spring can alsoassist in reducing and/or mitigating sudden movements and/or jitter ofthe clamping trigger 2610. Such a torsion spring can also automaticallyreturn the clamping trigger 2610 to its unactuated position when theclamping trigger 2610 is released. The actuator latch 2630 discussedabove can suitably hold the clamping trigger 2610 in its actuatedposition against the biasing force of the torsion spring.

As discussed above, the control system 1800 operates the electric motor1610 to open and close the jaw assembly 7100. The control system 1800 isconfigured to open and close the jaw assembly 7100 at the same speed. Insuch instances, the control system 1800 applies the same voltage pulsesto the electric motor 1610, albeit with different voltage polarities,when opening and closing the jaw assembly 7100. That said, the controlsystem 1800 can be configured to open and close the jaw assembly 7100 atdifferent speeds. For instance, the jaw assembly 7100 can be closed at afirst speed and opened at a second speed which is faster than the firstspeed. In such instances, the slower closing speed affords the clinicianan opportunity to better position the jaw assembly 7100 while clampingthe tissue. Alternatively, the control system 1800 can open the jawassembly 7100 at a slower speed. In such instances, the slower openingspeed reduces the possibility of the opening jaws colliding withadjacent tissue. In either event, the control system 1800 can decreasethe duration of the voltage pulses and/or increase the duration betweenthe voltage pulses to slow down and/or speed up the movement of the jawassembly 7100.

As discussed above, the control system 1800 is configured to interpretthe position of the clamping trigger 2610 as a command to position thejaw assembly 7100 in a specific configuration. For instance, the controlsystem 1800 is configured to interpret the proximal-most position of theclamping trigger 2610 as a command to close the jaw assembly 7100 andany other position of the clamping trigger as a command to open the jawassembly 7100. That said, the control system 1800 can be configured tointerpret the position of the clamping trigger 2610 in a proximal rangeof positions, instead of a single position, as a command to close thejaw assembly 7100. Such an arrangement can allow the jaw assembly 7000to be better responsive to the clinician's input. In such instances, therange of motion of the clamping trigger 2610 is divided into ranges—aproximal range which is interpreted as a command to close the jawassembly 7100 and a distal range which is interpreted as a command toopen the jaw assembly 7100. In at least one instance, the range ofmotion of the clamping trigger 2610 can have an intermediate rangebetween the proximal range and the distal range. When the clampingtrigger 2610 is in the intermediate range, the control system 1800 caninterpret the position of the clamping trigger 2610 as a command toneither open nor close the jaw assembly 7100. Such an intermediate rangecan prevent, or reduce the possibility of, jitter between the openingand closing ranges. In the instances described above, the control system1800 can be configured to ignore cumulative commands to open or closethe jaw assembly 7100. For instance, if the closure trigger 2610 hasalready been fully retracted into its proximal-most position, thecontrol assembly 1800 can ignore the motion of the clamping trigger 2610in the proximal, or clamping, range until the clamping trigger 2610enters into the distal, or opening, range wherein, at such point, thecontrol system 1800 can then actuate the electric motor 1610 to open thejaw assembly 7100.

In certain instances, further to the above, the position of the clampingtrigger 2610 within the clamping trigger range, or at least a portion ofthe clamping trigger range, can allow the clinician to control the speedof the electric motor 1610 and, thus, the speed in which the jawassembly 7100 is being opened or closed by the control assembly 1800. Inat least one instance, the sensor 2115 comprises a Hall Effect sensor,and/or any other suitable sensor, configured to detect the position ofthe clamping trigger 2610 between its distal, unactuated position andits proximal, fully-actuated position. The Hall Effect sensor isconfigured to transmit a signal to the handle control system 1800 viathe shaft control system 2800 such that the handle control system 1800can control the speed of the electric motor 1610 in response to theposition of the clamping trigger 2610. In at least one instance, thehandle control system 1800 controls the speed of the electric motor 1610proportionately, or in a linear manner, to the position of the clampingtrigger 2610. For example, if the clamping trigger 2610 is moved halfway through its range, then the handle control system 1800 will operatethe electric motor 1610 at half of the speed in which the electric motor1610 is operated when the clamping trigger 2610 is fully-retracted.Similarly, if the clamping trigger 2610 is moved a quarter way throughits range, then the handle control system 1800 will operate the electricmotor 1610 at a quarter of the speed in which the electric motor 1610 isoperated when the clamping trigger 2610 is fully-retracted. Otherembodiments are envisioned in which the handle control system 1800controls the speed of the electric motor 1610 in a non-linear manner tothe position of the clamping trigger 2610. In at least one instance, thecontrol system 1800 operates the electric motor 1610 slowly in thedistal portion of the clamping trigger range while quickly acceleratingthe speed of the electric motor 1610 in the proximal portion of theclamping trigger range.

As described above, the clamping trigger 2610 is movable to operate theelectric motor 1610 to open or close the jaw assembly 7100 of the endeffector 7000. The electric motor 1610 is also operable to rotate theend effector 7000 about a longitudinal axis and articulate the endeffector 7000 relative to the elongate shaft 2200 about the articulationjoint 2300 of the shaft assembly 2000. Referring primarily to FIGS. 509and 510 , the drive module 1100 comprises an input system 1400 includinga rotation actuator 1420 and an articulation actuator 1430. The inputsystem 1400 further comprises a printed circuit board (PCB) 1410 whichis in signal communication with the printed circuit board (PCB) 1810 ofthe control system 1800. The drive module 1100 comprises an electricalcircuit, such as a flexible wiring harness or ribbon, for example, whichpermits the input system 1400 to communicate with the control system1800. The rotation actuator 1420 is rotatably supported on the housing1110 and is in signal communication with the input board 1410 and/orcontrol board 1810, as described in greater detail below. Thearticulation actuator 1430 is supported by and in signal communicationwith the input board 1410 and/or control board 1810, as also describedin greater detail below.

Referring primarily to FIGS. 510, 512, and 513 , further to the above,the handle housing 1110 comprises an annular groove or slot definedtherein adjacent the distal mounting interface 1130. The rotationactuator 1420 comprises an annular ring 1422 rotatably supported withinthe annular groove and, owing to the configuration of the sidewalls ofthe annular groove, the annular ring 1422 is constrained fromtranslating longitudinally and/or laterally with respect to the handlehousing 1110. The annular ring 1422 is rotatable in a first, orclockwise, direction and a second, or counter-clockwise direction, abouta longitudinal axis extending through the frame 1500 of the drive module1100. The rotation actuator 1420 comprises one or more sensorsconfigured to detect the rotation of the annular ring 1422. In at leastone instance, the rotation actuator 1420 comprises a first sensorpositioned on a first side of the drive module 1100 and a second sensorpositioned on a second, or opposite, side of the drive module 1100 andthe annular ring 1422 comprises a detectable element which is detectableby the first and second sensors. The first sensor is configured todetect when the annular ring 1422 is rotated in the first direction andthe second sensor is configured to detect when the annular ring 1422 isrotated in the second direction. When the first sensor detects that theannular ring 1422 is rotated in the first direction, the handle controlsystem 1800 rotates the handle drive shaft 1710, the drive shaft 2710,and the end effector 7000 in the first direction, as described ingreater detail below. Similarly, the handle control system 1800 rotatesthe handle drive shaft 1710, the drive shaft 2710, and the end effector7000 in the second direction when the second sensor detects that theannular ring 1422 is rotated in the second direction. In view of theabove, the reader should appreciate that the clamping trigger 2610 andthe rotation actuator 1420 are both operable to rotate the drive shaft2710.

In various embodiments, further to the above, the first and secondsensors comprise switches which are mechanically closable by thedetectable element of the annular ring 1422. When the annular ring 1422is rotated in the first direction from a center position, the detectableelement closes the switch of the first sensor. When the switch of thefirst sensor is closed, the control system 1800 operates the electricmotor 1610 to rotate the end effector 7000 in the first direction. Whenthe annular ring 1422 is rotated in the second direction toward thecenter position, the detectable element is disengaged from the firstswitch and the first switch is re-opened. Once the first switch isre-opened, the control system 1800 cuts the power to the electric motor1610 to stop the rotation of the end effector 7000. Similarly, thedetectable element closes the switch of the second sensor when theannular ring 1422 is rotated in the second direction from the centerposition. When the switch of the second sensor is closed, the controlsystem 1800 operates the electric motor 1610 to rotate the end effector7000 in the second direction. When the annular ring 1422 is rotated inthe first direction toward the center position, the detectable elementis disengaged from the second switch and the second switch is re-opened.Once the second switch is re-opened, the control system 1800 cuts thepower to the electric motor 1610 to stop the rotation of the endeffector 7000.

In various embodiments, further to the above, the first and secondsensors of the rotation actuator 1420 comprise proximity sensors, forexample. In certain embodiments, the first and second sensors of therotation actuator 1420 comprise Hall Effect sensors, and/or any suitablesensors, configured to detect the distance between the detectableelement of the annular ring 1422 and the first and second sensors. Ifthe first Hall Effect sensor detects that the annular ring 1422 has beenrotated in the first direction, then, as discussed above, the controlsystem 1800 will rotate the end effector 7000 in the first direction. Inaddition, the control system 1800 can rotate the end effector 7000 at afaster speed when the detectable element is closer to the first HallEffect sensor than when the detectable element is further away from thefirst Hall Effect sensor. If the second Hall Effect sensor detects thatthe annular ring 1422 has been rotated in the second direction, then, asdiscussed above, the control system 1800 will rotate the end effector7000 in the second direction. In addition, the control system 1800 canrotate the end effector 7000 at a faster speed when the detectableelement is closer to the second Hall Effect sensor than when thedetectable element is further away from the second Hall Effect sensor.As a result, the speed in which the end effector 7000 is rotated is afunction of the amount, or degree, in which the annular ring 1422 isrotated. The control system 1800 is further configured to evaluate theinputs from both the first and second Hall Effect sensors whendetermining the direction and speed in which to rotate the end effector7000. In various instances, the control system 1800 can use the closestHall Effect sensor to the detectable element of the annular ring 1422 asa primary source of data and the Hall Effect sensor furthest away fromthe detectable element as a confirmational source of data todouble-check the data provided by the primary source of data. Thecontrol system 1800 can further comprise a data integrity protocol toresolve situations in which the control system 1800 is provided withconflicting data. In any event, the handle control system 1800 can enterinto a neutral state in which the handle control system 1800 does notrotate the end effector 7000 when the Hall Effect sensors detect thatthe detectable element is in its center position, or in a position whichis equidistant between the first Hall Effect sensor and the second HallEffect sensor. In at least one such instance, the control system 1800can enter into its neutral state when the detectable element is in acentral range of positions. Such an arrangement would prevent, or atleast reduce the possibility of, rotational jitter when the clinician isnot intending to rotate the end effector 7000.

Further to the above, the rotation actuator 1420 can comprise one ormore springs configured to center, or at least substantially center, therotation actuator 1420 when it is released by the clinician. In suchinstances, the springs can act to shut off the electric motor 1610 andstop the rotation of the end effector 7000. In at least one instance,the rotation actuator 1420 comprises a first torsion spring configuredto rotate the rotation actuator 1420 in the first direction and a secondtorsion spring configured to rotate the rotation actuator 1420 in thesecond direction. The first and second torsion springs can have thesame, or at least substantially the same, spring constant such that theforces and/or torques applied by the first and second torsion springsbalance, or at least substantially balance, the rotation actuator 1420in its center position.

In view of the above, the reader should appreciate that the clampingtrigger 2610 and the rotation actuator 1420 are both operable to rotatethe drive shaft 2710 and either, respectively, operate the jaw assembly7100 or rotate the end effector 7000. The system that uses the rotationof the drive shaft 2710 to selectively perform these functions isdescribed in greater detail below.

Referring to FIGS. 509 and 510 , the articulation actuator 1430comprises a first push button 1432 and a second push button 1434. Thefirst push button 1432 is part of a first articulation control circuitand the second push button 1434 is part of a second articulation circuitof the input system 1400. The first push button 1432 comprises a firstswitch that is closed when the first push button 1432 is depressed. Thehandle control system 1800 is configured to sense the closure of thefirst switch and, moreover, the closure of the first articulationcontrol circuit. When the handle control system 1800 detects that thefirst articulation control circuit has been closed, the handle controlsystem 1800 operates the electric motor 1610 to articulate the endeffector 7000 in a first articulation direction about the articulationjoint 2300. When the first push button 1432 is released by theclinician, the first articulation control circuit is opened which, oncedetected by the control system 1800, causes the control system 1800 tocut the power to the electric motor 1610 to stop the articulation of theend effector 7000.

In various instances, further to the above, the articulation range ofthe end effector 7000 is limited and the control system 1800 can utilizethe encoder system discussed above for monitoring the rotational outputof the electric motor 1610, for example, to monitor the amount, ordegree, in which the end effector 7000 is rotated in the firstdirection. In addition to or in lieu of the encoder system, the shaftassembly 2000 can comprise a first sensor configured to detect when theend effector 7000 has reached the limit of its articulation in the firstdirection. In any event, when the control system 1800 determines thatthe end effector 7000 has reached the limit of articulation in the firstdirection, the control system 1800 can cut the power to the electricmotor 1610 to stop the articulation of the end effector 7000.

Similar to the above, the second push button 1434 comprises a secondswitch that is closed when the second push button 1434 is depressed. Thehandle control system 1800 is configured to sense the closure of thesecond switch and, moreover, the closure of the second articulationcontrol circuit. When the handle control system 1800 detects that thesecond articulation control circuit has been closed, the handle controlsystem 1800 operates the electric motor 1610 to articulate the endeffector 7000 in a second direction about the articulation joint 2300.When the second push button 1434 is released by the clinician, thesecond articulation control circuit is opened which, once detected bythe control system 1800, causes the control system 1800 to cut the powerto the electric motor 1610 to stop the articulation of the end effector7000.

In various instances, the articulation range of the end effector 7000 islimited and the control system 1800 can utilize the encoder systemdiscussed above for monitoring the rotational output of the electricmotor 1610, for example, to monitor the amount, or degree, in which theend effector 7000 is rotated in the second direction. In addition to orin lieu of the encoder system, the shaft assembly 2000 can comprise asecond sensor configured to detect when the end effector 7000 hasreached the limit of its articulation in the second direction. In anyevent, when the control system 1800 determines that the end effector7000 has reached the limit of articulation in the second direction, thecontrol system 1800 can cut the power to the electric motor 1610 to stopthe articulation of the end effector 7000.

As described above, the end effector 7000 is articulatable in a firstdirection (FIG. 518 ) and/or a second direction (FIG. 519 ) from acenter, or unarticulated, position (FIG. 517 ). Once the end effector7000 has been articulated, the clinician can attempt to re-center theend effector 7000 by using the first and second articulation pushbuttons 1432 and 1434. As the reader can appreciate, the clinician maystruggle to re-center the end effector 7000 as, for instance, the endeffector 7000 may not be entirely visible once it is positioned in thepatient. In some instances, the end effector 7000 may not fit backthrough a trocar if the end effector 7000 is not re-centered, or atleast substantially re-centered. With that in mind, the control system1800 is configured to provide feedback to the clinician when the endeffector 7000 is moved into its unarticulated, or centered, position. Inat least one instance, the feedback comprises audio feedback and thehandle control system 1800 can comprise a speaker which emits a sound,such as a beep, for example, when the end effector 7000 is centered. Incertain instances, the feedback comprises visual feedback and the handlecontrol system 1800 can comprise a light emitting diode (LED), forexample, positioned on the handle housing 1110 which flashes when theend effector 7000 is centered. In various instances, the feedbackcomprises haptic feedback and the handle control system 1800 cancomprise an electric motor comprising an eccentric element whichvibrates the handle 1000 when the end effector 7000 is centered.Manually re-centering the end effector 7000 in this way can befacilitated by the control system 1800 slowing the motor 1610 when theend effector 7000 is approaching its centered position. In at least oneinstance, the control system 1800 slows the articulation of the endeffector 7000 when the end effector 7000 is within approximately 5degrees of center in either direction, for example.

In addition to or in lieu of the above, the handle control system 1800can be configured to re-center the end effector 7000. In at least onesuch instance, the handle control system 1800 can re-center the endeffector 7000 when both of the articulation buttons 1432 and 1434 of thearticulation actuator 1430 are depressed at the same time. When thehandle control system 1800 comprises an encoder system configured tomonitor the rotational output of the electric motor 1610, for example,the handle control system 1800 can determine the amount and direction ofarticulation needed to re-center, or at least substantially re-center,the end effector 7000. In various instances, the input system 1400 cancomprise a home button, for example, which, when depressed,automatically centers the end effector 7000.

Referring primarily to FIGS. 507 and 508 , the elongate shaft 2200 ofthe shaft assembly 2000 comprises an outer housing, or tube, 2210mounted to the proximal housing 2110 of the proximal portion 2100. Theouter housing 2210 comprises a longitudinal aperture 2230 extendingtherethrough and a proximal flange 2220 which secures the outer housing2210 to the proximal housing 2110. The frame 2500 of the shaft assembly2000 extends through the longitudinal aperture 2230 of the elongateshaft 2200. More specifically, the shaft 2510 of the shaft frame 2500necks down into a smaller shaft 2530 which extends through thelongitudinal aperture 2230. That said, the shaft frame 2500 can compriseany suitable arrangement. The drive system 2700 of the shaft assembly2000 also extends through the longitudinal aperture 2230 of the elongateshaft 2200. More specifically, the drive shaft 2710 of the shaft drivesystem 2700 necks down into a smaller drive shaft 2730 which extendsthrough the longitudinal aperture 2230. That said, the shaft drivesystem 2700 can comprise any suitable arrangement.

Referring primarily to FIGS. 522, 526, and 527 , the outer housing 2210of the elongate shaft 2200 extends to the articulation joint 2300. Thearticulation joint 2300 comprises a proximal frame 2310 mounted to theouter housing 2210 such that there is little, if any, relativetranslation and/or rotation between the proximal frame 2310 and theouter housing 2210. Referring primarily to FIG. 524 , the proximal frame2310 comprises an annular portion 2312 mounted to the sidewall of theouter housing 2210 and tabs 2314 extending distally from the annularportion 2312. The articulation joint 2300 further comprises links 2320and 2340 which are rotatably mounted to the frame 2310 and mounted to anouter housing 2410 of the distal attachment portion 2400. The link 2320comprises a distal end 2322 mounted to the outer housing 2410. Morespecifically, the distal end 2322 of the link 2320 is received andfixedly secured within a mounting slot 2412 defined in the outer housing2410. Similarly, the link 2340 comprises a distal end 2342 mounted tothe outer housing 2410. More specifically, the distal end 2342 of thelink 2340 is received and fixedly secured within a mounting slot definedin the outer housing 2410. The link 2320 comprises a proximal end 2324rotatably coupled to a tab 2314 of the proximal articulation frame 2310.Although not illustrated in FIG. 524 , a pin extends through aperturesdefined in the proximal end 2324 and the tab 2314 to define a pivot axistherebetween. Similarly, the link 2340 comprises a proximal end 2344rotatably coupled to a tab 2314 of the proximal articulation frame 2310.Although not illustrated in FIG. 524 , a pin extends through aperturesdefined in the proximal end 2344 and the tab 2314 to define a pivot axistherebetween. These pivot axes are collinear, or at least substantiallycollinear, and define an articulation axis A of the articulation joint2300.

Referring primarily to FIGS. 522, 526, and 527 , the outer housing 2410of the distal attachment portion 2400 comprises a longitudinal aperture2430 extending therethrough. The longitudinal aperture 2430 isconfigured to receive a proximal attachment portion 7400 of the endeffector 7000. The end effector 7000 comprises an outer housing 6230which is closely received within the longitudinal aperture 2430 of thedistal attachment portion 2400 such that there is little, if any,relative radial movement between the proximal attachment portion 7400 ofthe end effector 7000 and the distal attachment portion 2400 of theshaft assembly 2000. The proximal attachment portion 7400 furthercomprises an annular array of lock notches 7410 defined on the outerhousing 6230 which is releasably engaged by an end effector lock 6400 inthe distal attachment portion 2400 of the shaft assembly 2000. When theend effector lock 6400 is engaged with the array of lock notches 7410,the end effector lock 6400 prevents, or at least inhibits, relativelongitudinal movement between the proximal attachment portion 7400 ofthe end effector 7000 and the distal attachment portion 2400 of theshaft assembly 2000. As a result of the above, only relative rotationbetween the proximal attachment portion 7400 of the end effector 7000and the distal attachment portion 2400 of the shaft assembly 2000 ispermitted. To this end, the outer housing 6230 of the end effector 7000is closely received within the longitudinal aperture 2430 defined in thedistal attachment portion 2400 of the shaft assembly 2000.

Further to the above, referring to FIG. 523 , the outer housing 6230further comprises an annular slot, or recess, 6270 defined therein whichis configured to receive an O-ring 6275 therein. The O-ring 6275 iscompressed between the outer housing 6230 and the sidewall of thelongitudinal aperture 2430 when the end effector 7000 is inserted intothe distal attachment portion 2400. The O-ring 6275 is configured toresist, but permit, relative rotation between the end effector 7000 andthe distal attachment portion 2400 such that the O-ring 6275 canprevent, or reduce the possibility of, unintentional relative rotationbetween the end effector 7000 and the distal attachment portion 2400. Invarious instances, the O-ring 6275 can provide a seal between the endeffector 7000 and the distal attachment portion 2400 to prevent, or atleast reduce the possibility of, fluid ingress into the shaft assembly2000, for example.

Referring to FIGS. 516-523 , the jaw assembly 7100 of the end effector7000 comprises a first jaw 7110 and a second jaw 7120. Each jaw 7110,7120 comprises a distal end which is configured to assist a clinician indissecting tissue with the end effector 7000. Each jaw 7110, 7120further comprises a plurality of teeth which are configured to assist aclinician in grasping and holding onto tissue with the end effector7000. Moreover, referring primarily to FIG. 523 , each jaw 7110, 7120comprises a proximal end, i.e., proximal ends 7115, 7125, respectively,which rotatably connect the jaws 7110, 7120 together. Each proximal end7115, 7125 comprises an aperture extending therethrough which isconfigured to closely receive a pin 7130 therein. The pin 7130 comprisesa central body 7135 closely received within the apertures defined in theproximal ends 7115, 7125 of the jaws 7110, 7120 such that there islittle, if any, relative translation between the jaws 7110, 7120 and thepin 7130. The pin 7130 defines a jaw axis J about which the jaws 7110,7120 can be rotated and, also, rotatably mounts the jaws 7110, 7120 tothe outer housing 6230 of the end effector 7000. More specifically, theouter housing 6230 comprises distally-extending tabs 6235 havingapertures defined therein which are also configured to closely receivethe pin 7130 such that the jaw assembly 7100 does not translate relativeto a shaft portion 7200 of the end effector 7000. The pin 7130 furthercomprises enlarged ends which prevent the jaws 7110, 7120 from becomingdetached from the pin 7130 and also prevents the jaw assembly 7100 frombecoming detached from the shaft portion 7200. This arrangement definesa rotation joint 7300.

Referring primarily to FIGS. 523 and 526 , the jaws 7110 and 7120 arerotatable between their open and closed positions by a jaw assemblydrive including drive links 7140, a drive nut 7150, and a drive screw6130. As described in greater detail below, the drive screw 6130 isselectively rotatable by the drive shaft 2730 of the shaft drive system2700. The drive screw 6130 comprises an annular flange 6132 which isclosely received within a slot, or groove, 6232 (FIG. 528 ) defined inthe outer housing 6230 of the end effector 7000. The sidewalls of theslot 6232 are configured to prevent, or at least inhibit, longitudinaland/or radial translation between the drive screw 6130 and the outerhousing 6230, but yet permit relative rotational motion between thedrive screw 6130 and the outer housing 6230. The drive screw 6130further comprises a threaded end 6160 which is threadably engaged with athreaded aperture 7160 defined in the drive nut 7150. The drive nut 7150is constrained from rotating with the drive screw 6130 and, as a result,the drive nut 7150 is translated when the drive screw 6130 is rotated.In use, the drive screw 6130 is rotated in a first direction to displacethe drive nut 7150 proximally and in a second, or opposite, direction todisplace the drive nut 7150 distally. The drive nut 7150 furthercomprises a distal end 7155 comprising an aperture defined therein whichis configured to closely receive pins 7145 extending from the drivelinks 7140. Referring primarily to FIG. 523 , a first drive link 7140 isattached to one side of the distal end 7155 and a second drive link 7140is attached to the opposite side of the distal end 7155. The first drivelink 7140 comprises another pin 7145 extending therefrom which isclosely received in an aperture defined in the proximal end 7115 of thefirst jaw 7110 and, similarly, the second drive link 7140 comprisesanother pin extending therefrom which is closely received in an aperturedefined in the proximal end 7125 of the second jaw 7120. As a result ofthe above, the drive links 7140 operably connect the jaws 7110 and 7120to the drive nut 7150. When the drive nut 7150 is driven proximally bythe drive screw 6130, as described above, the jaws 7110, 7120 arerotated into the closed, or clamped, configuration. Correspondingly, thejaws 7110, 7120 are rotated into their open configuration when the drivenut 7150 is driven distally by the drive screw 6130.

As discussed above, the control system 1800 is configured to actuate theelectric motor 1610 to perform three different end effectorfunctions—clamping/opening the jaw assembly 7100 (FIGS. 516 and 517 ),rotating the end effector 7000 about a longitudinal axis (FIGS. 520 and521 ), and articulating the end effector 7000 about an articulation axis(FIGS. 518 and 519 ). Referring primarily to FIGS. 529 and 530 , thecontrol system 1800 is configured to operate a transmission 6000 toselectively perform these three end effector functions. The transmission6000 comprises a first clutch system 6100 configured to selectivelytransmit the rotation of the drive shaft 2730 to the drive screw 6130 ofthe end effector 7000 to open or close the jaw assembly 7100, dependingon the direction in which the drive shaft 2730 is rotated. Thetransmission 6000 further comprises a second clutch system 6200configured to selectively transmit the rotation of the drive shaft 2730to the outer housing 6230 of the end effector 7000 to rotate the endeffector 7000 about the longitudinal axis L. The transmission 6000 alsocomprises a third clutch system 6300 configured to selectively transmitthe rotation of the drive shaft 2730 to the articulation joint 2300 toarticulate the distal attachment portion 2400 and the end effector 7000about the articulation axis A. The clutch systems 6100, 6200, and 6300are in electrical communication with the control system 1800 viaelectrical circuits extending through the shaft 2510, the connector pins2520, the connector pins 1520, and the shaft 1510, for example. In atleast one instance, each of these clutch control circuits comprises twoconnector pins 2520 and two connector pins 1520, for example.

In various instances, further to the above, the shaft 2510 and/or theshaft 1510 comprise a flexible circuit including electrical traces whichform part of the clutch control circuits. The flexible circuit cancomprise a ribbon, or substrate, with conductive pathways definedtherein and/or thereon. The flexible circuit can also comprise sensorsand/or any solid state component, such as signal smoothing capacitors,for example, mounted thereto. In at least one instance, each of theconductive pathways can comprise one or more signal smoothing capacitorswhich can, among other things, even out fluctuations in signalstransmitted through the conductive pathways. In various instances, theflexible circuit can be coated with at least one material, such as anelastomer, for example, which can seal the flexible circuit againstfluid ingress.

Referring primarily to FIG. 531 , the first clutch system 6100 comprisesa first clutch 6110, an expandable first drive ring 6120, and a firstelectromagnetic actuator 6140. The first clutch 6110 comprises anannular ring and is slideably disposed on the drive shaft 2730. Thefirst clutch 6110 is comprised of a magnetic material and is movablebetween a disengaged, or unactuated, position (FIG. 531 ) and anengaged, or actuated, position (FIG. 532 ) by electromagnetic fields EFgenerated by the first electromagnetic actuator 6140. In variousinstances, the first clutch 6110 is at least partially comprised of ironand/or nickel, for example. In at least one instance, the first clutch6110 comprises a permanent magnet. As illustrated in FIG. 525 , thedrive shaft 2730 comprises one or more longitudinal key slots 6115defined therein which are configured to constrain the longitudinalmovement of the clutch 6110 relative to the drive shaft 2730. Morespecifically, the clutch 6110 comprises one or more keys extending intothe key slots 6115 such that the distal ends of the key slots 6115 stopthe distal movement of the clutch 6110 and the proximal ends of the keyslots 6115 stop the proximal movement of the clutch 6110.

When the first clutch 6110 is in its disengaged position (FIG. 531 ),the first clutch 6110 rotates with the drive shaft 2130 but does nottransmit rotational motion to the first drive ring 6120. As can be seenin FIG. 531 , the first clutch 6110 is separated from, or not in contactwith, the first drive ring 6120. As a result, the rotation of the driveshaft 2730 and the first clutch 6110 is not transmitted to the drivescrew 6130 when the first clutch assembly 6100 is in its disengagedstate. When the first clutch 6110 is in its engaged position (FIG. 532), the first clutch 6110 is engaged with the first drive ring 6120 suchthat the first drive ring 6120 is expanded, or stretched, radiallyoutwardly into contact with the drive screw 6130. In at least oneinstance, the first drive ring 6120 comprises an elastomeric band, forexample. As can be seen in FIG. 532 , the first drive ring 6120 iscompressed against an annular inner sidewall 6135 of the drive screw6130. As a result, the rotation of the drive shaft 2730 and the firstclutch 6110 is transmitted to the drive screw 6130 when the first clutchassembly 6100 is in its engaged state. Depending on the direction inwhich the drive shaft 2730 is rotated, the first clutch assembly 6100can move the jaw assembly 7100 into its open and closed configurationswhen the first clutch assembly 6100 is in its engaged state.

As described above, the first electromagnetic actuator 6140 isconfigured to generate magnetic fields to move the first clutch 6110between its disengaged (FIG. 531 ) and engaged (FIG. 532 ) positions.For instance, referring to FIG. 531 , the first electromagnetic actuator6140 is configured to emit a magnetic field EF_(L) which repulses, ordrives, the first clutch 6110 away from the first drive ring 6120 whenthe first clutch assembly 6100 is in its disengaged state. The firstelectromagnetic actuator 6140 comprises one or more wound coils in acavity defined in the shaft frame 2530 which generate the magnetic fieldEF_(L) when current flows in a first direction through a firstelectrical clutch circuit including the wound coils. The control system1800 is configured to apply a first voltage polarity to the firstelectrical clutch circuit to create the current flowing in the firstdirection. The control system 1800 can continuously apply the firstvoltage polarity to the first electric shaft circuit to continuouslyhold the first clutch 6110 in its disengaged position. While such anarrangement can prevent the first clutch 6110 from unintentionallyengaging the first drive ring 6120, such an arrangement can also consumea lot of power. Alternatively, the control system 1800 can apply thefirst voltage polarity to the first electrical clutch circuit for asufficient period of time to position the first clutch 6110 in itsdisengaged position and then discontinue applying the first voltagepolarity to the first electric clutch circuit, thereby resulting in alower consumption of power. That being said, the first clutch assembly6100 further comprises a first clutch lock 6150 mounted in the drivescrew 6130 which is configured to releasably hold the first clutch 6110in its disengaged position. The first clutch lock 6150 is configured toprevent, or at least reduce the possibility of, the first clutch 6110from becoming unintentionally engaged with the first drive ring 6120.When the first clutch 6110 is in its disengaged position, as illustratedin FIG. 531 , the first clutch lock 6150 interferes with the freemovement of the first clutch 6110 and holds the first clutch 6110 inposition via a friction force and/or an interference force therebetween.In at least one instance, the first clutch lock 6150 comprises anelastomeric plug, seat, or detent, comprised of rubber, for example. Incertain instances, the first clutch lock 6150 comprises a permanentmagnet which holds the first clutch 6110 in its disengaged position byan electromagnetic force. In any event, the first electromagneticactuator 6140 can apply an electromagnetic pulling force to the firstclutch 6110 that overcomes these forces, as described in greater detailbelow.

Further to the above, referring to FIG. 532 , the first electromagneticactuator 6140 is configured to emit a magnetic field EF_(D) which pulls,or drives, the first clutch 6110 toward the first drive ring 6120 whenthe first clutch assembly 6100 is in its engaged state. The coils of thefirst electromagnetic actuator 6140 generate the magnetic field EF_(D)when current flows in a second, or opposite, direction through the firstelectrical clutch circuit. The control system 1800 is configured toapply an opposite voltage polarity to the first electrical clutchcircuit to create the current flowing in the opposite direction. Thecontrol system 1800 can continuously apply the opposite voltage polarityto the first electrical clutch circuit to continuously hold the firstclutch 6110 in its engaged position and maintain the operable engagementbetween the first drive ring 6120 and the drive screw 6130.Alternatively, the first clutch 6110 can be configured to become wedgedwithin the first drive ring 6120 when the first clutch 6110 is in itsengaged position and, in such instances, the control system 1800 may notneed to continuously apply a voltage polarity to the first electricalclutch circuit to hold the first clutch assembly 6100 in its engagedstate. In such instances, the control system 1800 can discontinueapplying the voltage polarity once the first clutch 6110 has beensufficiently wedged in the first drive ring 6120.

Notably, further to the above, the first clutch lock 6150 is alsoconfigured to lockout the jaw assembly drive when the first clutch 6110is in its disengaged position. More specifically, referring again toFIG. 531 , the first clutch 6110 pushes the first clutch lock 6150 inthe drive screw 6130 into engagement with the outer housing 6230 of theend effector 7000 when the first clutch 6110 is in its disengagedposition such that the drive screw 6130 does not rotate, or at leastsubstantially rotate, relative to the outer housing 6230. The outerhousing 6230 comprises a slot 6235 defined therein which is configuredto receive the first clutch lock 6150. When the first clutch 6110 ismoved into its engaged position, referring to FIG. 532 , the firstclutch 6110 is no longer engaged with the first clutch lock 6150 and, asa result, the first clutch lock 6150 is no longer biased into engagementwith the outer housing 6230 and the drive screw 6130 can rotate freelywith respect to the outer housing 6230. As a result of the above, thefirst clutch 6110 can do at least two things—operate the jaw drive whenthe first clutch 6110 is in its engaged position and lock out the jawdrive when the first clutch 6110 is in its disengaged position.

Moreover, further to the above, the threads of the threaded portions6160 and 7160 can be configured to prevent, or at least resist,backdriving of the jaw drive. In at least one instance, the thread pitchand/or angle of the threaded portions 6160 and 7160, for example, can beselected to prevent the backdriving, or unintentional opening, of thejaw assembly 7100. As a result of the above, the possibility of the jawassembly 7100 unintentionally opening or closing is prevented, or atleast reduced.

Referring primarily to FIG. 533 , the second clutch system 6200comprises a second clutch 6210, an expandable second drive ring 6220,and a second electromagnetic actuator 6240. The second clutch 6210comprises an annular ring and is slideably disposed on the drive shaft2730. The second clutch 6210 is comprised of a magnetic material and ismovable between a disengaged, or unactuated, position (FIG. 533 ) and anengaged, or actuated, position (FIG. 534 ) by electromagnetic fields EFgenerated by the second electromagnetic actuator 6240. In variousinstances, the second clutch 6210 is at least partially comprised ofiron and/or nickel, for example. In at least one instance, the secondclutch 6210 comprises a permanent magnet. As illustrated in FIG. 525 ,the drive shaft 2730 comprises one or more longitudinal key slots 6215defined therein which are configured to constrain the longitudinalmovement of the second clutch 6210 relative to the drive shaft 2730.More specifically, the second clutch 6210 comprises one or more keysextending into the key slots 6215 such that the distal ends of the keyslots 6215 stop the distal movement of the second clutch 6210 and theproximal ends of the key slots 6215 stop the proximal movement of thesecond clutch 6210.

When the second clutch 6210 is in its disengaged position, referring toFIG. 533 , the second clutch 6210 rotates with the drive shaft 2730 butdoes not transmit rotational motion to the second drive ring 6220. Ascan be seen in FIG. 533 , the second clutch 6210 is separated from, ornot in contact with, the second drive ring 6220. As a result, therotation of the drive shaft 2730 and the second clutch 6210 is nottransmitted to the outer housing 6230 of the end effector 7000 when thesecond clutch assembly 6200 is in its disengaged state. When the secondclutch 6210 is in its engaged position (FIG. 534 ), the second clutch6210 is engaged with the second drive ring 6220 such that the seconddrive ring 6220 is expanded, or stretched, radially outwardly intocontact with the outer housing 6230. In at least one instance, thesecond drive ring 6220 comprises an elastomeric band, for example. Ascan be seen in FIG. 534 , the second drive ring 6220 is compressedagainst an annular inner sidewall 7415 of the outer housing 6230. As aresult, the rotation of the drive shaft 2730 and the second clutch 6210is transmitted to the outer housing 6230 when the second clutch assembly6200 is in its engaged state. Depending on the direction in which thedrive shaft 2730 is rotated, the second clutch assembly 6200 can rotatethe end effector 7000 in a first direction or a second direction aboutthe longitudinal axis L when the second clutch assembly 6200 is in itsengaged state.

As described above, the second electromagnetic actuator 6240 isconfigured to generate magnetic fields to move the second clutch 6210between its disengaged (FIG. 533 ) and engaged (FIG. 534 ) positions.For instance, the second electromagnetic actuator 6240 is configured toemit a magnetic field EF_(L) which repulses, or drives, the secondclutch 6210 away from the second drive ring 6220 when the second clutchassembly 6200 is in its disengaged state. The second electromagneticactuator 6240 comprises one or more wound coils in a cavity defined inthe shaft frame 2530 which generate the magnetic field EF_(L) whencurrent flows in a first direction through a second electrical clutchcircuit including the wound coils. The control system 1800 is configuredto apply a first voltage polarity to the second electrical clutchcircuit to create the current flowing in the first direction. Thecontrol system 1800 can continuously apply the first voltage polarity tothe second electric clutch circuit to continuously hold the secondclutch 6120 in its disengaged position. While such an arrangement canprevent the second clutch 6210 from unintentionally engaging the seconddrive ring 6220, such an arrangement can also consume a lot of power.Alternatively, the control system 1800 can apply the first voltagepolarity to the second electrical clutch circuit for a sufficient periodof time to position the second clutch 6210 in its disengaged positionand then discontinue applying the first voltage polarity to the secondelectric clutch circuit, thereby resulting in a lower consumption ofpower. That being said, the second clutch assembly 6200 furthercomprises a second clutch lock 6250 mounted in the outer housing 6230which is configured to releasably hold the second clutch 6210 in itsdisengaged position. Similar to the above, the second clutch lock 6250can prevent, or at least reduce the possibility of, the second clutch6210 from becoming unintentionally engaged with the second drive ring6220. When the second clutch 6210 is in its disengaged position, asillustrated in FIG. 533 , the second clutch lock 6250 interferes withthe free movement of the second clutch 6210 and holds the second clutch6210 in position via a friction and/or interference force therebetween.In at least one instance, the second clutch lock 6250 comprises anelastomeric plug, seat, or detent, comprised of rubber, for example. Incertain instances, the second clutch lock 6250 comprises a permanentmagnet which holds the second clutch 6210 in its disengaged position byan electromagnetic force. That said, the second electromagnetic actuator6240 can apply an electromagnetic pulling force to the second clutch6210 that overcomes these forces, as described in greater detail below.

Further to the above, referring to FIG. 534 , the second electromagneticactuator 6240 is configured to emit a magnetic field EF_(D) which pulls,or drives, the second clutch 6210 toward the second drive ring 6220 whenthe second clutch assembly 6200 is in its engaged state. The coils ofthe second electromagnetic actuator 6240 generate the magnetic fieldEF_(D) when current flows in a second, or opposite, direction throughthe second electrical shaft circuit. The control system 1800 isconfigured to apply an opposite voltage polarity to the secondelectrical shaft circuit to create the current flowing in the oppositedirection. The control system 1800 can continuously apply the oppositevoltage polarity to the second electric shaft circuit to continuouslyhold the second clutch 6210 in its engaged position and maintain theoperable engagement between the second drive ring 6220 and the outerhousing 6230. Alternatively, the second clutch 6210 can be configured tobecome wedged within the second drive ring 6220 when the second clutch6210 is in its engaged position and, in such instances, the controlsystem 1800 may not need to continuously apply a voltage polarity to thesecond shaft electrical circuit to hold the second clutch assembly 6200in its engaged state. In such instances, the control system 1800 candiscontinue applying the voltage polarity once the second clutch 6210has been sufficiently wedged in the second drive ring 6220.

Notably, further to the above, the second clutch lock 6250 is alsoconfigured to lockout the rotation of the end effector 7000 when thesecond clutch 6210 is in its disengaged position. More specifically,referring again to FIG. 533 , the second clutch 6210 pushes the secondclutch lock 6250 in the outer shaft 6230 into engagement with thearticulation link 2340 when the second clutch 6210 is in its disengagedposition such that the end effector 7000 does not rotate, or at leastsubstantially rotate, relative to the distal attachment portion 2400 ofthe shaft assembly 2000. As illustrated in FIG. 530 , the second clutchlock 6250 is positioned or wedged within a slot, or channel, 2345defined in the articulation link 2340 when the second clutch 6210 is inits disengaged position. As a result of the above, the possibility ofthe end effector 7000 unintentionally rotating is prevented, or at leastreduced. Moreover, as a result of the above, the second clutch 6210 cando at least two things—operate the end effector rotation drive when thesecond clutch 6210 is in its engaged position and lock out the endeffector rotation drive when the second clutch 6210 is in its disengagedposition.

Referring primarily to FIGS. 524, 527, and 528 , the shaft assembly 2000further comprises an articulation drive system configured to articulatethe distal attachment portion 2400 and the end effector 7000 about thearticulation joint 2300. The articulation drive system comprises anarticulation drive 6330 rotatably supported within the distal attachmentportion 2400. That said, the articulation drive 6330 is closely receivedwithin the distal attachment portion 2400 such that the articulationdrive 6330 does not translate, or at least substantially translate,relative to the distal attachment portion 2400. The articulation drivesystem of the shaft assembly 2000 further comprises a stationary gear2330 fixedly mounted to the articulation frame 2310. More specifically,the stationary gear 2330 is fixedly mounted to a pin connecting a tab2314 of the articulation frame 2310 and the articulation link 2340 suchthat the stationary gear 2330 does not rotate relative to thearticulation frame 2310. The stationary gear 2330 comprises a centralbody 2335 and an annular array of stationary teeth 2332 extending aroundthe perimeter of the central body 2335. The articulation drive 6330comprises an annular array of drive teeth 6332 which is meshinglyengaged with the stationary teeth 2332. When the articulation drive 6330is rotated, the articulation drive 6330 pushes against the stationarygear 2330 and articulates the distal attachment portion 2400 of theshaft assembly 2000 and the end effector 7000 about the articulationjoint 2300.

Referring primarily to FIG. 535 , the third clutch system 6300 comprisesa third clutch 6310, an expandable third drive ring 6320, and a thirdelectromagnetic actuator 6340. The third clutch 6310 comprises anannular ring and is slideably disposed on the drive shaft 2730. Thethird clutch 6310 is comprised of a magnetic material and is movablebetween a disengaged, or unactuated, position (FIG. 535 ) and anengaged, or actuated, position (FIG. 536 ) by electromagnetic fields EFgenerated by the third electromagnetic actuator 6340. In variousinstances, the third clutch 6310 is at least partially comprised of ironand/or nickel, for example. In at least one instance, the third clutch6310 comprises a permanent magnet. As illustrated in FIG. 525 , thedrive shaft 2730 comprises one or more longitudinal key slots 6315defined therein which are configured to constrain the longitudinalmovement of the third clutch 6310 relative to the drive shaft 2730. Morespecifically, the third clutch 6310 comprises one or more keys extendinginto the key slots 6315 such that the distal ends of the key slots 6315stop the distal movement of the third clutch 6310 and the proximal endsof the key slots 6315 stop the proximal movement of the third clutch6310.

When the third clutch 6310 is in its disengaged position, referring toFIG. 535 , the third clutch 6310 rotates with the drive shaft 2730 butdoes not transmit rotational motion to the third drive ring 6320. As canbe seen in FIG. 535 , the third clutch 6310 is separated from, or not incontact with, the third drive ring 6320. As a result, the rotation ofthe drive shaft 2730 and the third clutch 6310 is not transmitted to thearticulation drive 6330 when the third clutch assembly 6300 is in itsdisengaged state. When the third clutch 6310 is in its engaged position,referring to FIG. 536 , the third clutch 6310 is engaged with the thirddrive ring 6320 such that the third drive ring 6320 is expanded, orstretched, radially outwardly into contact with the articulation drive6330. In at least one instance, the third drive ring 6320 comprises anelastomeric band, for example. As can be seen in FIG. 536 , the thirddrive ring 6320 is compressed against an annular inner sidewall 6335 ofthe articulation drive 6330. As a result, the rotation of the driveshaft 2730 and the third clutch 6310 is transmitted to the articulationdrive 6330 when the third clutch assembly 6300 is in its engaged state.Depending on the direction in which the drive shaft 2730 is rotated, thethird clutch assembly 6300 can articulate the distal attachment portion2400 of the shaft assembly 2000 and the end effector 7000 in a first orsecond direction about the articulation joint 2300.

As described above, the third electromagnetic actuator 6340 isconfigured to generate magnetic fields to move the third clutch 6310between its disengaged (FIG. 535 ) and engaged (FIG. 536 ) positions.For instance, referring to FIG. 535 , the third electromagnetic actuator6340 is configured to emit a magnetic field EF_(L) which repulses, ordrives, the third clutch 6310 away from the third drive ring 6320 whenthe third clutch assembly 6300 is in its disengaged state. The thirdelectromagnetic actuator 6340 comprises one or more wound coils in acavity defined in the shaft frame 2530 which generate the magnetic fieldEF_(L) when current flows in a first direction through a thirdelectrical clutch circuit including the wound coils. The control system1800 is configured to apply a first voltage polarity to the thirdelectrical clutch circuit to create the current flowing in the firstdirection. The control system 1800 can continuously apply the firstvoltage polarity to the third electric clutch circuit to continuouslyhold the third clutch 6310 in its disengaged position. While such anarrangement can prevent the third clutch 6310 from unintentionallyengaging the third drive ring 6320, such an arrangement can also consumea lot of power. Alternatively, the control system 1800 can apply thefirst voltage polarity to the third electrical clutch circuit for asufficient period of time to position the third clutch 6310 in itsdisengaged position and then discontinue applying the first voltagepolarity to the third electric clutch circuit, thereby resulting in alower consumption of power.

Further to the above, the third electromagnetic actuator 6340 isconfigured to emit a magnetic field EF_(D) which pulls, or drives, thethird clutch 6310 toward the third drive ring 6320 when the third clutchassembly 6300 is in its engaged state. The coils of the thirdelectromagnetic actuator 6340 generate the magnetic field EF_(D) whencurrent flows in a second, or opposite, direction through the thirdelectrical clutch circuit. The control system 1800 is configured toapply an opposite voltage polarity to the third electrical shaft circuitto create the current flowing in the opposite direction. The controlsystem 1800 can continuously apply the opposite voltage polarity to thethird electric shaft circuit to continuously hold the third clutch 6310in its engaged position and maintain the operable engagement between thethird drive ring 6320 and the articulation drive 6330. Alternatively,the third clutch 6210 can be configured to become wedged within thethird drive ring 6320 when the third clutch 6310 is in its engagedposition and, in such instances, the control system 1800 may not need tocontinuously apply a voltage polarity to the third shaft electricalcircuit to hold the third clutch assembly 6300 in its engaged state. Insuch instances, the control system 1800 can discontinue applying thevoltage polarity once the third clutch 6310 has been sufficiently wedgedin the third drive ring 6320. In any event, the end effector 7000 isarticulatable in a first direction or a second direction, depending onthe direction in which the drive shaft 2730 is rotated, when the thirdclutch assembly 6300 is in its engaged state.

Further to the above, referring to FIGS. 524, 535, and 536 , thearticulation drive system further comprises a lockout 6350 whichprevents, or at least inhibits, the articulation of the distalattachment portion 2400 of the shaft assembly 2000 and the end effector7000 about the articulation joint 2300 when the third clutch 6310 is inits disengaged position (FIG. 535 ). Referring primarily to FIG. 524 ,the articulation link 2340 comprises a slot, or groove, 2350 definedtherein wherein the lockout 6350 is slideably positioned in the slot2350 and extends at least partially under the stationary articulationgear 2330. The lockout 6350 comprises at attachment hook 6352 engagedwith the third clutch 6310. More specifically, the third clutch 6310comprises an annular slot, or groove, 6312 defined therein and theattachment hook 6352 is positioned in the annular slot 6312 such thatthe lockout 6350 translates with the third clutch 6310. Notably,however, the lockout 6350 does not rotate, or at least substantiallyrotate, with the third clutch 6310. Instead, the annular groove 6312 inthe third clutch 6310 permits the third clutch 6310 to rotate relativeto the lockout 6350. The lockout 6350 further comprises a lockout hook6354 slideably positioned in a radially-extending lockout slot 2334defined in the bottom of the stationary gear 2330. When the third clutch6310 is in its disengaged position, as illustrated in FIG. 535 , thelockout 6350 is in a locked position in which the lockout hook 6354prevents the end effector 7000 from rotating about the articulationjoint 2300. When the third clutch 6310 is in its engaged position, asillustrated in FIG. 536 , the lockout 6350 is in an unlocked position inwhich the lockout hook 6354 is no longer positioned in the lockout slot2334. Instead, the lockout hook 6354 is positioned in a clearance slotdefined in the middle or body 2335 of the stationary gear 2330. In suchinstances, the lockout hook 6354 can rotate within the clearance slotwhen the end effector 7000 rotates about the articulation joint 2300.

Further to the above, the radially-extending lockout slot 2334 depictedin FIGS. 535 and 536 extends longitudinally, i.e., along an axis whichis parallel to the longitudinal axis of the elongate shaft 2200. Oncethe end effector 7000 has been articulated, however, the lockout hook6354 is no longer aligned with the longitudinal lockout slot 2334. Withthis in mind, the stationary gear 2330 comprises a plurality, or anarray, of radially-extending lockout slots 2334 defined in the bottom ofthe stationary gear 2330 such that, when the third clutch 6310 isdeactuated and the lockout 6350 is pulled distally after the endeffector 7000 has been articulated, the lockout hook 6354 can enter oneof the lockout slots 2334 and lock the end effector 7000 in itsarticulated position. Thus, as a result, the end effector 7000 can belocked in an unarticulated and an articulated position. In variousinstances, the lockout slots 2334 can define discrete articulatedpositions for the end effector 7000. For instance, the lockout slots2334 can be defined at 10 degree intervals, for example, which candefine discrete articulation orientations for the end effector 7000 at10 degree intervals. In other instances, these orientations can be at 5degree intervals, for example. In alternative embodiments, the lockout6350 comprises a brake that engages a circumferential shoulder definedin the stationary gear 2330 when the third clutch 6310 is disengagedfrom the third drive ring 6320. In such an embodiment, the end effector7000 can be locked in any suitable orientation. In any event, thelockout 6350 prevents, or at least reduces the possibility of, the endeffector 7000 unintentionally articulating. As a result of the above,the third clutch 6310 can do things—operate the articulation drive whenit is in its engaged position and lock out the articulation drive whenit is in its disengaged position.

Referring primarily to FIGS. 527 and 528 , the shaft frame 2530 and thedrive shaft 2730 extend through the articulation joint 2300 into thedistal attachment portion 2400. When the end effector 7000 isarticulated, as illustrated in FIGS. 518 and 519 , the shaft frame 2530and the drive shaft 2730 bend to accommodate the articulation of the endeffector 7000. Thus, the shaft frame 2530 and the drive shaft 2730 arecomprised of any suitable material which accommodates the articulationof the end effector 7000. Moreover, as discussed above, the shaft frame2530 houses the first, second, and third electromagnetic actuators 6140,6240, and 6340. In various instances, the first, second, and thirdelectromagnetic actuators 6140, 6240, and 6340 each comprise wound wirecoils, such as copper wire coils, for example, and the shaft frame 2530is comprised of an insulative material to prevent, or at least reducethe possibility of, short circuits between the first, second, and thirdelectromagnetic actuators 6140, 6240, and 6340. In various instances,the first, second, and third electrical clutch circuits extendingthrough the shaft frame 2530 are comprised of insulated electricalwires, for example. Further to the above, the first, second, and thirdelectrical clutch circuits place the electromagnetic actuators 6140,6240, and 6340 in communication with the control system 1800 in thedrive module 1100.

As described above, the clutches 6110, 6210, and/or 6310 can be held intheir disengaged positions so that they do not unintentionally move intotheir engaged positions. In various arrangements, the clutch system 6000comprises a first biasing member, such as a spring, for example,configured to bias the first clutch 6110 into its disengaged position, asecond biasing member, such as a spring, for example, configured to biasthe second clutch 6210 into its disengaged position, and/or a thirdbiasing member, such as a spring, for example, configured to bias thethird clutch 6110 into its disengaged position. In such arrangements,the biasing forces of the springs can be selectively overcome by theelectromagnetic forces generated by the electromagnetic actuators whenenergized by an electrical current. Further to the above, the clutches6110, 6210, and/or 6310 can be retained in their engaged positions bythe drive rings 6120, 6220, and/or 6320, respectively. Morespecifically, in at least one instance, the drive rings 6120, 6220,and/or 6320 are comprised of an elastic material which grips orfrictionally holds the clutches 6110, 6210, and/or 6310, respectively,in their engaged positions. In various alternative embodiments, theclutch system 6000 comprises a first biasing member, such as a spring,for example, configured to bias the first clutch 6110 into its engagedposition, a second biasing member, such as a spring, for example,configured to bias the second clutch 6210 into its engaged position,and/or a third biasing member, such as a spring, for example, configuredto bias the third clutch 6110 into its engaged position. In sucharrangements, the biasing forces of the springs can be overcome by theelectromagnetic forces applied by the electromagnetic actuators 6140,6240, and/or 6340, respectively, as needed to selectively hold theclutches 6110, 6210, and 6310 in their disengaged positions. In any oneoperational mode of the surgical system, the control assembly 1800 canenergize one of the electromagnetic actuators to engage one of theclutches while energizing the other two electromagnetic actuators todisengage the other two clutches.

Although the clutch system 6000 comprises three clutches to controlthree drive systems of the surgical system, a clutch system can compriseany suitable number of clutches to control any suitable number ofsystems. Moreover, although the clutches of the clutch system 6000 slideproximally and distally between their engaged and disengaged positions,the clutches of a clutch system can move in any suitable manner. Inaddition, although the clutches of the clutch system 6000 are engagedone at a time to control one drive motion at a time, various instancesare envisioned in which more than one clutch can be engaged to controlmore than one drive motion at a time.

In view of the above, the reader should appreciate that the controlsystem 1800 is configured to, one, operate the motor system 1600 torotate the drive shaft system 2700 in an appropriate direction and, two,operate the clutch system 6000 to transfer the rotation of the driveshaft system 2700 to the appropriate function of the end effector 7000.Moreover, as discussed above, the control system 1800 is responsive toinputs from the clamping trigger system 2600 of the shaft assembly 2000and the input system 1400 of the handle 1000. When the clamping triggersystem 2600 is actuated, as discussed above, the control system 1800activates the first clutch assembly 6100 and deactivates the secondclutch assembly 6200 and the third clutch assembly 6300. In suchinstances, the control system 1800 also supplies power to the motorsystem 1600 to rotate the drive shaft system 2700 in a first directionto clamp the jaw assembly 7100 of the end effector 7000. When thecontrol system 1800 detects that the jaw assembly 7100 is in its clampedconfiguration, the control system 1800 stops the motor assembly 1600 anddeactivates the first clutch assembly 6100. When the control system 1800detects that the clamping trigger system 2600 has been moved to, or isbeing moved to, its unactuated position, the control system 1800activates, or maintains the activation of, the first clutch assembly6100 and deactivates, or maintains the deactivation of, the secondclutch assembly 6200 and the third clutch assembly 6300. In suchinstances, the control system 1800 also supplies power to the motorsystem 1600 to rotate the drive shaft system 2700 in a second directionto open the jaw assembly 7100 of the end effector 7000.

When the rotation actuator 1420 is actuated in a first direction,further to the above, the control system 1800 activates the secondclutch assembly 6200 and deactivates the first clutch assembly 6100 andthe third clutch assembly 6300. In such instances, the control system1800 also supplies power to the motor system 1600 to rotate the driveshaft system 2700 in a first direction to rotate the end effector 7000in a first direction. When the control system 1800 detects that therotation actuator 1420 has been actuated in a second direction, thecontrol system 1800 activates, or maintains the activation of, thesecond clutch assembly 6200 and deactivates, or maintains thedeactivation of, the first clutch assembly 6100 and the third clutchassembly 6300. In such instances, the control system 1800 also suppliespower to the motor system 1600 to rotate the drive shaft system 2700 ina second direction to rotate the drive shaft system 2700 in a seconddirection to rotate the end effector 7000 in a second direction. Whenthe control system 1800 detects that the rotation actuator 1420 is notactuated, the control system 1800 deactivates the second clutch assembly6200.

When the first articulation actuator 1432 is depressed, further to theabove, the control system 1800 activates the third clutch assembly 6300and deactivates the first clutch assembly 6100 and the second clutchassembly 6200. In such instances, the control system 1800 also suppliespower to the motor system 1600 to rotate the drive shaft system 2700 ina first direction to articulate the end effector 7000 in a firstdirection. When the control system 1800 detects that the secondarticulation actuator 1434 is depressed, the control system 1800activates, or maintains the activation of, the third clutch assembly6200 and deactivates, or maintains the deactivation of, the first clutchassembly 6100 and the second clutch assembly 6200. In such instances,the control system 1800 also supplies power to the motor system 1600 torotate the drive shaft system 2700 in a second direction to articulatethe end effector 7000 in a second direction. When the control system1800 detects that neither the first articulation actuator 1432 nor thesecond articulation actuator 1434 are actuated, the control system 1800deactivates the third clutch assembly 6200.

Further to the above, the control system 1800 is configured to changethe operating mode of the stapling system based on the inputs itreceives from the clamping trigger system 2600 of the shaft assembly2000 and the input system 1400 of the handle 1000. The control system1800 is configured to shift the clutch system 6000 before rotating theshaft drive system 2700 to perform the corresponding end effectorfunction. Moreover, the control system 1800 is configured to stop therotation of the shaft drive system 2700 before shifting the clutchsystem 6000. Such an arrangement can prevent the sudden movements in theend effector 7000. Alternatively, the control system 1800 can shift theclutch system 600 while the shaft drive system 2700 is rotating. Such anarrangement can allow the control system 1800 to shift quickly betweenoperating modes.

As discussed above, referring to FIG. 537 , the distal attachmentportion 2400 of the shaft assembly 2000 comprises an end effector lock6400 configured to prevent the end effector 7000 from beingunintentionally decoupled from the shaft assembly 2000. The end effectorlock 6400 comprises a lock end 6410 selectively engageable with theannular array of lock notches 7410 defined on the proximal attachmentportion 7400 of the end effector 7000, a proximal end 6420, and a pivot6430 rotatably connecting the end effector lock 6400 to the articulationlink 2320. When the third clutch 6310 of the third clutch assembly 6300is in its disengaged position, as illustrated in FIG. 537 , the thirdclutch 6310 is contact with the proximal end 6420 of the end effectorlock 6400 such that the lock end 6410 of the end effector lock 6400 isengaged with the array of lock notches 7410. In such instances, the endeffector 7000 can rotate relative to the end effector lock 6400 butcannot translate relative to the distal attachment portion 2400. Whenthe third clutch 6310 is moved into its engaged position, as illustratedin FIG. 538 , the third clutch 6310 is no longer engaged with theproximal end 6420 of the end effector lock 6400. In such instances, theend effector lock 6400 is free to pivot upwardly and permit the endeffector 7000 to be detached from the shaft assembly 2000.

The above being said, referring again to FIG. 537 , it is possible thatthe second clutch 6210 of the second clutch assembly 6200 is in itsdisengaged position when the clinician detaches, or attempts to detach,the end effector 7000 from the shaft assembly 2000. As discussed above,the second clutch 6210 is engaged with the second clutch lock 6250 whenthe second clutch 6210 is in its disengaged position and, in suchinstances, the second clutch lock 6250 is pushed into engagement withthe articulation link 2340. More specifically, the second clutch lock6250 is positioned in the channel 2345 defined in the articulation 2340when the second clutch 6210 is engaged with the second clutch lock 6250which may prevent, or at least impede, the end effector 7000 from beingdetached from the shaft assembly 2000. To facilitate the release of theend effector 7000 from the shaft assembly 2000, the control system 1800can move the second clutch 6210 into its engaged position in addition tomoving the third clutch 6310 into its engaged position. In suchinstances, the end effector 7000 can clear both the end effector lock6400 and the second clutch lock 6250 when the end effector 7000 isremoved.

In at least one instance, further to the above, the drive module 1100comprises an input switch and/or sensor in communication with thecontrol system 1800 via the input system 1400, and/or the control system1800 directly, which, when actuated, causes the control system 1800 tounlock the end effector 7000. In various instances, the drive module1100 comprises an input screen 1440 in communication with the board 1410of the input system 1400 which is configured to receive an unlock inputfrom the clinician. In response to the unlock input, the control system1800 can stop the motor system 1600, if it is running, and unlock theend effector 7000 as described above. The input screen 1440 is alsoconfigured to receive a lock input from the clinician in which the inputsystem 1800 moves the second clutch assembly 6200 and/or the thirdclutch assembly 6300 into their unactuated states to lock the endeffector 7000 to the shaft assembly 2000.

FIG. 540 depicts a shaft assembly 2000′ in accordance with at least onealternative embodiment. The shaft assembly 2000′ is similar to the shaftassembly 2000 in many respects, most of which will not be repeatedherein for the sake of brevity. Similar to the shaft assembly 2000, theshaft assembly 2000′ comprises a shaft frame, i.e., shaft frame 2530′.The shaft frame 2530′ comprises a longitudinal passage 2535′ and, inaddition, a plurality of clutch position sensors, i.e., a first sensor6180′, a second sensor 6280′, and a third sensor 6380′ positioned in theshaft frame 2530′. The first sensor 6180′ is in signal communicationwith the control system 1800 as part of a first sensing circuit. Thefirst sensing circuit comprises signal wires extending through thelongitudinal passage 2535′; however, the first sensing circuit cancomprise a wireless signal transmitter and receiver to place the firstsensor 6180′ in signal communication with the control system 1800. Thefirst sensor 6180′ is positioned and arranged to detect the position ofthe first clutch 6110 of the first clutch assembly 6100. Based on datareceived from the first sensor 6180′, the control system 1800 candetermine whether the first clutch 6110 is in its engaged position, itsdisengaged position, or somewhere in-between. With this information, thecontrol system 1800 can assess whether or not the first clutch 6110 isin the correct position given the operating state of the surgicalinstrument. For instance, if the surgical instrument is in its jawclamping/opening operating state, the control system 1800 can verifywhether the first clutch 6110 is properly positioned in its engagedposition. In such instances, further to the below, the control system1800 can also verify that the second clutch 6210 is in its disengagedposition via the second sensor 6280′ and that the third clutch 6310 isin its disengaged position via the third sensor 6380′. Correspondingly,the control system 1800 can verify whether the first clutch 6110 isproperly positioned in its disengaged position if the surgicalinstrument is not in its jaw clamping/opening state. To the extent thatthe first clutch 6110 is not in its proper position, the control system1800 can actuate the first electromagnetic actuator 6140 in an attemptto properly position the first clutch 6110. Likewise, the control system1800 can actuate the electromagnetic actuators 6240 and/or 6340 toproperly position the clutches 6210 and/or 6310, if necessary.

The second sensor 6280′ is in signal communication with the controlsystem 1800 as part of a second sensing circuit. The second sensingcircuit comprises signal wires extending through the longitudinalpassage 2535′; however, the second sensing circuit can comprise awireless signal transmitter and receiver to place the second sensor6280′ in signal communication with the control system 1800. The secondsensor 6280′ is positioned and arranged to detect the position of thesecond clutch 6210 of the first clutch assembly 6200. Based on datareceived from the second sensor 6280′, the control system 1800 candetermine whether the second clutch 6210 is in its engaged position, itsdisengaged position, or somewhere in-between. With this information, thecontrol system 1800 can assess whether or not the second clutch 6210 isin the correct position given the operating state of the surgicalinstrument. For instance, if the surgical instrument is in its endeffector rotation operating state, the control system 1800 can verifywhether the second clutch 6210 is properly positioned in its engagedposition. In such instances, the control system 1800 can also verifythat the first clutch 6110 is in its disengaged position via the firstsensor 6180′ and, further to the below, the control system 1800 can alsoverify that the third clutch 6310 is in its disengaged position via thethird sensor 6380′. Correspondingly, the control system 1800 can verifywhether the second clutch 6110 is properly positioned in its disengagedposition if the surgical instrument is not in its end effector rotationstate. To the extent that the second clutch 6210 is not in its properposition, the control system 1800 can actuate the second electromagneticactuator 6240 in an attempt to properly position the second clutch 6210.Likewise, the control system 1800 can actuate the electromagneticactuators 6140 and/or 6340 to properly position the clutches 6110 and/or6310, if necessary.

The third sensor 6380′ is in signal communication with the controlsystem 1800 as part of a third sensing circuit. The third sensingcircuit comprises signal wires extending through the longitudinalpassage 2535′; however, the third sensing circuit can comprise awireless signal transmitter and receiver to place the third sensor 6380′in signal communication with the control system 1800. The third sensor6380′ is positioned and arranged to detect the position of the thirdclutch 6310 of the third clutch assembly 6300. Based on data receivedfrom the third sensor 6380′, the control system 1800 can determinewhether the third clutch 6310 is in its engaged position, its disengagedposition, or somewhere in-between. With this information, the controlsystem 1800 can assess whether or not the third clutch 6310 is in thecorrect position given the operating state of the surgical instrument.For instance, if the surgical instrument is in its end effectorarticulation operating state, the control system 1800 can verify whetherthe third clutch 6310 is properly positioned in its engaged position. Insuch instances, the control system 1800 can also verify that the firstclutch 6110 is in its disengaged position via the first sensor 6180′ andthat the second clutch 6210 is in its disengaged position via the secondsensor 6280′. Correspondingly, the control system 1800 can verifywhether the third clutch 6310 is properly positioned in its disengagedposition if the surgical instrument is not in its end effectorarticulation state. To the extent that the third clutch 6310 is not inits proper position, the control system 1800 can actuate the thirdelectromagnetic actuator 6340 in an attempt to properly position thethird clutch 6310. Likewise, the control system 1800 can actuate theelectromagnetic actuators 6140 and/or 6240 to properly position theclutches 6110 and/or 6210, if necessary.

Further to the above, the clutch position sensors, i.e., the firstsensor 6180′, the second sensor 6280′, and the third sensor 6380′ cancomprise any suitable type of sensor. In various instances, the firstsensor 6180′, the second sensor 6280′, and the third sensor 6380′ eachcomprise a proximity sensor. In such an arrangement, the sensors 6180′,6280′, and 6380′ are configured to detect whether or not the clutches6110, 6210, and 6310, respectively, are in their engaged positions. Invarious instances, the first sensor 6180′, the second sensor 6280′, andthe third sensor 6380′ each comprise a Hall Effect sensor, for example.In such an arrangement, the sensors 6180′, 6280′, and 6380′ can not onlydetect whether or not the clutches 6110, 6210, and 6310, respectively,are in their engaged positions but the sensors 6180′, 6280′, and 6380′can also detect how close the clutches 6110, 6210, and 6310 are withrespect to their engaged or disengaged positions.

FIG. 541 depicts the shaft assembly 2000′ and an end effector 7000″ inaccordance with at least one alternative embodiment. The end effector7000″ is similar to the end effector 7000 in many respects, most ofwhich will not be repeated herein for the sake of brevity. Similar tothe end effector 7000, the shaft assembly 7000″ comprises a jaw assembly7100 and a jaw assembly drive configured to move the jaw assembly 7100between its open and closed configurations. The jaw assembly drivecomprises drive links 7140, a drive nut 7150″, and a drive screw 6130″.The drive nut 7150″ comprises a sensor 7190″ positioned therein which isconfigured to detect the position of a magnetic element 6190″ positionedin the drive screw 6130″. The magnetic element 6190″ is positioned in anelongate aperture 6134″ defined in the drive screw 6130″ and cancomprise a permanent magnet and/or can be comprised of iron, nickel,and/or any suitable metal, for example. In various instances, the sensor7190″ comprises a proximity sensor, for example, which is in signalcommunication with the control system 1800. In certain instances, thesensor 7190″ comprises a Hall Effect sensor, for example, in signalcommunication with the control system 1800. In certain instances, thesensor 7190″ comprises an optical sensor, for example, and thedetectable element 6190″ comprises an optically detectable element, suchas a reflective element, for example. In either event, the sensor 7190″is configured to communicate wirelessly with the control system 1800 viaa wireless signal transmitter and receiver and/or via a wired connectionextending through the shaft frame passage 2532′, for example.

The sensor 7190″, further to the above, is configured to detect when themagnetic element 6190″ is adjacent to the sensor 7190″ such that thecontrol system 1800 can use this data to determine that the jaw assembly7100 has reached the end of its clamping stroke. At such point, thecontrol system 1800 can stop the motor assembly 1600. The sensor 7190″and the control system 1800 are also configured to determine thedistance between where the drive screw 6130″ is currently positioned andwhere the drive screw 6130″ should be positioned at the end of itsclosure stroke in order to calculate the amount of closure stroke of thedrive screw 6130″ that is still needed to close the jaw assembly 7100.Moreover, such information can be used by the control system 1800 toassess the current configuration of the jaw assembly 7100, i.e., whetherthe jaw assembly 7100 is in its open configuration, its closedconfiguration, or a partially closed configuration. The sensor systemcould be used to determine when the jaw assembly 7100 has reached itsfully open position and stop the motor assembly 1600 at that point. Invarious instances, the control system 1800 could use this sensor systemto confirm that the first clutch assembly 6100 is in its actuated stateby confirming that the jaw assembly 7100 is moving while the motorassembly 1600 is turning. Similarly, the control system 1800 could usethis sensor system to confirm that the first clutch assembly 6100 is inits unactuated state by confirming that the jaw assembly 7100 is notmoving while the motor assembly 1600 is turning.

FIG. 542 depicts a shaft assembly 2000′″ and an end effector 7000′ inaccordance with at least one alternative embodiment. The shaft assembly2000′″ is similar to the shaft assemblies 2000 and 2000′ in manyrespects, most of which will not be repeated herein for the sake ofbrevity. The end effector 7000′″ is similar to the end effectors 7000and 7000″ in many respects, most of which will not be repeated hereinfor the sake of brevity. Similar to the end effector 7000, the endeffector 7000′″ comprises a jaw assembly 7100 and a jaw assembly driveconfigured to move the jaw assembly 7100 between its open and closedconfigurations and, in addition, an end effector rotation drive thatrotates the end effector 7000′″ relative to the distal attachmentportion 2400 of the shaft assembly 2000′. The end effector rotationdrive comprises an outer housing 6230′″ that is rotated relative to ashaft frame 2530′″ of the end effector 7000′″ by the second clutchassembly 6200. The shaft frame 2530′″ comprises a sensor 6290′″positioned therein which is configured to detect the position of amagnetic element 6190′″ positioned in and/or on the outer housing6230′″. The magnetic element 6190′″ can comprise a permanent magnetand/or can be comprised of iron, nickel, and/or any suitable metal, forexample. In various instances, the sensor 6290′″ comprises a proximitysensor, for example, in signal communication with the control system1800. In certain instances, the sensor 6290′″ comprises a Hall Effectsensor, for example, in signal communication with the control system1800. In either event, the sensor 6290′″ is configured to communicatewirelessly with the control system 1800 via a wireless signaltransmitter and receiver and/or via a wired connection extending throughthe shaft frame passage 2532′, for example. In various instances, thecontrol system 1800 can use the sensor 6290′″ to confirm whether themagnetic element 6190′″ is rotating and, thus, confirm that the secondclutch assembly 6200 is in its actuated state. Similarly, the controlsystem 1800 can use the sensor 6290′″ to confirm whether the magneticelement 6190′″ is not rotating and, thus, confirm that the second clutchassembly 6200 is in its unactuated state. The control system 1800 canalso use the sensor 6290′″ to confirm that the second clutch assembly6200 is in its unactuated state by confirming that the second clutch6210 is positioned adjacent the sensor 6290′″.

FIG. 543 depicts a shaft assembly 2000″″ in accordance with at least onealternative embodiment. The shaft assembly 2000″″ is similar to theshaft assemblies 2000, 2000′, and 2000′″ in many respects, most of whichwill not be repeated herein for the sake of brevity. Similar to theshaft assembly 2000, the shaft assembly 2000″″ comprises, among otherthings, an elongate shaft 2200, an articulation joint 2300, and a distalattachment portion 2400 configured to receive an end effector, such asend effector 7000′, for example. Similar to the shaft assembly 2000, theshaft assembly 2000″″ comprises an articulation drive, i.e.,articulation drive 6330″″ configured to rotate the distal attachmentportion 2400 and the end effector 7000′ about the articulation joint2300. Similar to the above, a shaft frame 2530″″ comprises a sensorpositioned therein configured to detect the position, and/or rotation,of a magnetic element 6390″″ positioned in and/or on the articulationdrive 6330″″. The magnetic element 6390″″ can comprise a permanentmagnet and/or can be comprised of iron, nickel, and/or any suitablemetal, for example. In various instances, the sensor comprises aproximity sensor, for example, in signal communication with the controlsystem 1800. In certain instances, the sensor comprises a Hall Effectsensor, for example, in signal communication with the control system1800. In either event, the sensor is configured to communicatewirelessly with the control system 1800 via a wireless signaltransmitter and receiver and/or via a wired connection extending throughthe shaft frame passage 2532′, for example. In various instances, thecontrol system 1800 can use the sensor to confirm whether the magneticelement 6390″″ is rotating and, thus, confirm that the third clutchassembly 6300 is in its actuated state. Similarly, the control system1800 can use the sensor to confirm whether the magnetic element 6390″″is not rotating and, thus, confirm that the third clutch assembly 6300is in its unactuated state. In certain instances, the control system1800 can use the sensor to confirm that the third clutch assembly 6300is in its unactuated state by confirming that the third clutch 6310 ispositioned adjacent the sensor.

Referring to FIG. 543 once again, the shaft assembly 2000″″ comprises anend effector lock 6400′ configured to releasably lock the end effector7000′, for example, to the shaft assembly 2000″″. The end effector lock6400′ is similar to the end effector lock 6400 in many respects, most ofwhich will not be discussed herein for the sake of brevity. Notably,though, a proximal end 6420′ of the lock 6400′ comprises a tooth 6422′configured to engage the annular slot 6312 of the third clutch 6310 andreleasably hold the third clutch 6310 in its disengaged position. Thatsaid, the actuation of the third electromagnetic assembly 6340 candisengage the third clutch 6310 from the end effector lock 6400′.Moreover, in such instances, the proximal movement of the third clutch6310 into its engaged position rotates the end effector lock 6400′ intoa locked position and into engagement with the lock notches 7410 to lockthe end effector 7000′ to the shaft assembly 2000″″. Correspondingly,the distal movement of the third clutch 6310 into its disengagedposition unlocks the end effector 7000′ and allows the end effector7000′ to be disassembled from the shaft assembly 2000″″.

Further to the above, an instrument system including a handle and ashaft assembly attached thereto can be configured to perform adiagnostic check to assess the state of the clutch assemblies 6100,6200, and 6300. In at least one instance, the control system 1800sequentially actuates the electromagnetic actuators 6140, 6240, and/or6340—in any suitable order—to verify the positions of the clutches 6110,6210, and/or 6310, respectively, and/or verify that the clutches areresponsive to the electromagnetic actuators and, thus, not stuck. Thecontrol system 1800 can use sensors, including any of the sensorsdisclosed herein, to verify the movement of the clutches 6110, 6120, and6130 in response to the electromagnetic fields created by theelectromagnetic actuators 6140, 6240, and/or 6340. In addition, thediagnostic check can also include verifying the motions of the drivesystems. In at least one instance, the control system 1800 sequentiallyactuates the electromagnetic actuators 6140, 6240, and/or 6340—in anysuitable order—to verify that the jaw drive opens and/or closes the jawassembly 7100, the rotation drive rotates the end effector 7000, and/orthe articulation drive articulates the end effector 7000, for example.The control system 1800 can use sensors to verify the motions of the jawassembly 7100 and end effector 7000.

The control system 1800 can perform the diagnostic test at any suitabletime, such as when a shaft assembly is attached to the handle and/orwhen the handle is powered on, for example. If the control system 1800determines that the instrument system passed the diagnostic test, thecontrol system 1800 can permit the ordinary operation of the instrumentsystem. In at least one instance, the handle can comprise an indicator,such as a green LED, for example, which indicates that the diagnosticcheck has been passed. If the control system 1800 determines that theinstrument system failed the diagnostic test, the control system 1800can prevent and/or modify the operation of the instrument system. In atleast one instance, the control system 1800 can limit the functionalityof the instrument system to only the functions necessary to remove theinstrument system from the patient, such as straightening the endeffector 7000 and/or opening and closing the jaw assembly 7100, forexample. In at least one respect, the control system 1800 enters into alimp mode. The limp mode of the control system 1800 can reduce a currentrotational speed of the motor 1610 by any percentage selected from arange of about 75% to about 25%, for example. In one example, the limpmode reduces a current rotational speed of the motor 1610 by 50%. In oneexample, the limp mode reduces the current rotational speed of the motor1610 by 75%. The limp mode may cause a current torque of the motor 1610to be reduced by any percentage selected from a range of about 75% toabout 25%, for example. In one example, the limp mode reduces a currenttorque of the motor 1610 by 50%. The handle can comprise an indicator,such as a red LED, for example, which indicates that the instrumentsystem failed the diagnostic check and/or that the instrument system hasentered into a limp mode. The above being said, any suitable feedbackcan be used to warn the clinician that the instrument system is notoperating properly such as, for example, an audible warning and/or atactile or vibratory warning, for example.

FIGS. 544-546 depict a clutch system 6000′ in accordance with at leastone alternative embodiment. The clutch system 6000′ is similar to theclutch system 6000 in many respects, most of which will not be repeatedherein for the sake of brevity. Similar to the clutch system 6000, theclutch system 6000′ comprises a clutch assembly 6100′ which isactuatable to selectively couple a rotatable drive input 6030′ with arotatable drive output 6130′. The clutch assembly 6100′ comprises clutchplates 6110′ and drive rings 6120′. The clutch plates 6110′ arecomprised of a magnetic material, such as iron and/or nickel, forexample, and can comprise a permanent magnet. As described in greaterdetail below, the clutch plates 6110′ are movable between unactuatedpositions (FIG. 545 ) and actuated positions (FIG. 546 ) within thedrive output 6130′. The clutch plates 6110′ are slideably positioned inapertures defined in the drive output 6130′ such that the clutch plates6110′ rotate with the drive output 6130′ regardless of whether theclutch plates 6110′ are in their unactuated or actuated positions.

When the clutch plates 6110′ are in their unactuated positions, asillustrated in FIG. 545 , the rotation of the drive input 6030′ is nottransferred to the drive output 6130′. More specifically, when the driveinput 6030′ is rotated, in such instances, the drive input 6030′ slidespast and rotates relative to the drive rings 6120′ and, as a result, thedrive rings 6120′ do not drive the clutch plates 6110′ and the driveoutput 6130′. When the clutch plates 6110′ are in their actuatedpositions, as illustrated in FIG. 546 , the clutch plates 6110′resiliently compress the drive rings 6120′ against the drive input6030′. The drive rings 6120′ are comprised of any suitable compressiblematerial, such as rubber, for example. In any event, in such instances,the rotation of the drive input 6030′ is transferred to the drive output6130′ via the drive rings 6120′ and the clutch plates 6110′. The clutchsystem 6000′ comprises a clutch actuator 6140′ configured to move theclutch plates 6110′ into their actuated positions. The clutch actuator6140′ is comprised of a magnetic material such as iron and/or nickel,for example, and can comprise a permanent magnet. The clutch actuator6140′ is slideably positioned in a longitudinal shaft frame 6050′extending through the drive input 6030′ and can be moved between anunactuated position (FIG. 545 ) and an actuated position (FIG. 546 ) bya clutch shaft 6060′. In at least one instance, the clutch shaft 6060′comprises a polymer cable, for example. When the clutch actuator 6140′is in its actuated position, as illustrated in FIG. 546 , the clutchactuator 6140′ pulls the clutch plates 6110′ inwardly to compress thedrive rings 6120′, as discussed above. When the clutch actuator 6140′ ismoved into its unactuated position, as illustrated in FIG. 545 , thedrive rings 6120′ resiliently expand and push the clutch plates 6110′away from the drive input 6030′. In various alternative embodiments, theclutch actuator 6140′ can comprise an electromagnet. In such anarrangement, the clutch actuator 6140′ can be actuated by an electricalcircuit extending through a longitudinal aperture defined in the clutchshaft 6060′, for example. In various instances, the clutch system 6000′further comprises electrical wires 6040′, for example, extending throughthe longitudinal aperture.

FIG. 547 depicts an end effector 7000 a including a jaw assembly 7100 a,a jaw assembly drive, and a clutch system 6000 a in accordance with atleast one alternative embodiment. The jaw assembly 7100 a comprises afirst jaw 7110 a and a second jaw 7120 a which are selectively rotatableabout a pivot 7130 a. The jaw assembly drive comprises a translatableactuator rod 7160 a and drive links 7140 a which are pivotably coupledto the actuator rod 7160 a about a pivot 7150 a. The drive links 7140 aare also pivotably coupled to the jaws 7110 a and 7120 a such that thejaws 7110 a and 7120 a are rotated closed when the actuator rod 7160 ais pulled proximally and rotated open when the actuator rod 7160 a ispushed distally. The clutch system 6000 a is similar to the clutchsystems 6000 and 6000′ in many respects, most of which will not berepeated herein for the sake of brevity. The clutch system 6000 acomprises a first clutch assembly 6100 a and a second clutch assembly6200 a which are configured to selectively transmit the rotation of adrive input 6030 a to rotate the jaw assembly 7100 a about alongitudinal axis and articulate the jaw assembly 7100 a about anarticulation joint 7300 a, respectively, as described in greater detailbelow.

The first clutch assembly 6100 a comprises clutch plates 6110 a anddrive rings 6120 a and work in a manner similar to the clutch plates6110′ and drive rings 6120′ discussed above. When the clutch pates 6110a are actuated by an electromagnetic actuator 6140 a, the rotation ofthe drive input 6030 a is transferred to an outer shaft housing 7200 a.More specifically, the outer shaft housing 7200 a comprises a proximalouter housing 7210 a and a distal outer housing 7220 a which isrotatably supported by the proximal outer housing 7210 a and is rotatedrelative to the proximal outer housing 7210 a by the drive input 6030 awhen the clutch plates 6110 a are in their actuated position. Therotation of the distal outer housing 7220 a rotates the jaw assembly7100 a about the longitudinal axis owing to fact that the pivot 7130 aof the jaw assembly 7100 a is mounted to the distal outer housing 7220a. As a result, the outer shaft housing 7200 a rotates the jaw assembly7100 a in a first direction when the outer shaft housing 7200 a isrotated in a first direction by the drive input 6030 a. Similarly, theouter shaft housing 7200 a rotates the jaw assembly 7100 a in a seconddirection when the outer shaft housing 7200 a is rotated in a seconddirection by the drive input 6030 a. When the electromagnetic actuator6140 a is de-energized, the drive rings 6120 a expand and the clutchplates 6110 a are moved into their unactuated positions, therebydecoupling the end effector rotation drive from the drive input 6030 a.

The second clutch assembly 6200 a comprises clutch plates 6210 a anddrive rings 6220 a and work in a manner similar to the clutch plates6110′ and drive rings 6120′ discussed above. When the clutch pates 6210a are actuated by an electromagnetic actuator 6240 a, the rotation ofthe drive input 6030 a is transferred to an articulation drive 6230 a.The articulation drive 6230 a is rotatably supported within an outershaft housing 7410 a of an end effector attachment portion 7400 a and isrotatably supported by a shaft frame 6050 a extending through the outershaft housing 7410 a. The articulation drive 6230 a comprises a gearface defined thereon which is operably intermeshed with a stationarygear face 7230 a defined on the proximal outer housing 7210 a of theouter shaft housing 7200 a. As a result, the articulation drive 6230 aarticulates the outer shaft housing 7200 a and the jaw assembly 7100 ain a first direction when the articulation drive 6230 a is rotated in afirst direction by the drive input 6030 a. Similarly, the articulationdrive 6230 a articulates the outer shaft housing 7200 a and the jawassembly 7100 a in a second direction when the articulation drive 6230 ais rotated in a second direction by the drive input 6030 a. When theelectromagnetic actuator 6240 a is de-energized, the drive rings 6220 aexpand and the clutch plates 6210 a are moved into their unactuatedpositions, thereby decoupling the end effector articulation drive fromthe drive input 6030 a.

Further to the above, the shaft assembly 4000 is illustrated in FIGS.548-552 . The shaft assembly 4000 is similar to the shaft assemblies2000, 2000′, 2000′″, and 2000″″ in many respects, most of which will notbe repeated herein for the sake of brevity. The shaft assembly 4000comprises a proximal portion 4100, an elongate shaft 4200, a distalattachment portion 2400, and an articulate joint 2300 which rotatablyconnects the distal attachment portion 2040 to the elongate shaft 4200.The proximal portion 4100, similar to the proximal portion 2100, isoperably attachable to the drive module 1100 of the handle 1000. Theproximal portion 4100 comprises a housing 4110 including an attachmentinterface 4130 configured to mount the shaft assembly 4000 to theattachment interface 1130 of the handle 1000. The shaft assembly 4000further comprises a frame 4500 including a shaft 4510 configured to becoupled to the shaft 1510 of the handle frame 1500 when the shaftassembly 4000 is attached to the handle 1000. The shaft assembly 4000also comprises a drive system 4700 including a rotatable drive shaft4710 configured to be operably coupled to the drive shaft 1710 of thehandle drive system 1700 when the shaft assembly 4000 is attached to thehandle 1000. The distal attachment portion 2400 is configured to receivean end effector, such as end effector 8000, for example. The endeffector 8000 is similar to the end effector 7000 in many respects, mostof which will not be repeated herein for the sake of brevity. That said,the end effector 8000 comprises a jaw assembly 8100 configured to, amongother things, grasp tissue.

As discussed above, referring primarily to FIGS. 550-552 , the frame4500 of the shaft assembly 4000 comprises a frame shaft 4510. The frameshaft 4510 comprises a notch, or cut-out, 4530 defined therein. Asdiscussed in greater detail below, the cut-out 4530 is configured toprovide clearance for a jaw closure actuation system 4600. The frame4500 further comprises a distal portion 4550 and a bridge 4540connecting the distal portion 4550 to the frame shaft 4510. The frame4500 further comprises a longitudinal portion 4560 extending through theelongate shaft 4200 to the distal attachment portion 2400. Similar tothe above, the frame shaft 4510 comprises one or more electrical tracesdefined thereon and/or therein. The electrical traces extend through thelongitudinal portion 4560, the distal portion 4550, the bridge 4540,and/or any suitable portion of the frame shaft 4510 to the electricalcontacts 2520. Referring primarily to FIG. 551 , the distal portion 4550and longitudinal portion 4560 comprise a longitudinal aperture definedtherein which is configured to receive a rod 4660 of the jaw closureactuation system 4600, as described in greater detail below.

As also discussed above, referring primarily to FIGS. 551 and 552 , thedrive system 4700 of the shaft assembly 4000 comprises a drive shaft4710. The drive shaft 4710 is rotatably supported within the proximalshaft housing 4110 by the frame shaft 4510 and is rotatable about alongitudinal axis extending through the frame shaft 4510. The drivesystem 4700 further comprises a transfer shaft 4750 and an output shaft4780. The transfer shaft 4750 is also rotatably supported within theproximal shaft housing 4110 and is rotatable about a longitudinal axisextending parallel to, or at least substantially parallel to, the frameshaft 4510 and the longitudinal axis defined therethrough. The transfershaft 4750 comprises a proximal spur gear 4740 fixedly mounted theretosuch that the proximal spur gear 4740 rotates with the transfer shaft4750. The proximal spur gear 4740 is operably intermeshed with anannular gear face 4730 defined around the outer circumference of thedrive shaft 4710 such that the rotation of the drive shaft 4710 istransferred to the transfer shaft 4750. The transfer shaft 4750 furthercomprises a distal spur gear 4760 fixedly mounted thereto such that thedistal spur gear 4760 rotates with the transfer shaft 4750. The distalspur gear 4760 is operably intermeshed with an annular gear 4770 definedaround the outer circumference of the output shaft 4780 such that therotation of the transfer shaft 4750 is transferred to the output shaft4780. Similar to the above, the output shaft 4780 is rotatably supportedwithin the proximal shaft housing 4110 by the distal portion 4550 of theshaft frame 4500 such that the output shaft 4780 rotates about thelongitudinal shaft axis. Notably, the output shaft 4780 is not directlycoupled to the input shaft 4710; rather, the output shaft 4780 isoperably coupled to the input shaft 4710 by the transfer shaft 4750.Such an arrangement provides room for the manually-actuated jaw closureactuation system 4600 discussed below.

Further to the above, referring primarily to FIGS. 550 and 551 , the jawclosure actuation system 4600 comprises an actuation, or scissors,trigger 4610 rotatably coupled to the proximal shaft housing 4110 abouta pivot 4620. The actuation trigger 4610 comprises an elongate portion4612, a proximal end 4614, and a grip ring aperture 4616 defined in theproximal end 4614 which is configured to be gripped by the clinician.The shaft assembly 4000 further comprises a stationary grip 4160extending from the proximal housing 4110. The stationary grip 4160comprises an elongate portion 4162, a proximal end 4164, and a grip ringaperture 4166 defined in the proximal end 4164 which is configured to begripped by the clinician. In use, as described in greater detail below,the actuation trigger 4610 is rotatable between an unactuated positionand an actuated position (FIG. 551 ), i.e., toward the stationary grip4160, to close the jaw assembly 8100 of the end effector 8000.

Referring primarily to FIG. 551 , the jaw closure actuation system 4600further comprises a drive link 4640 rotatably coupled to the proximalshaft housing 4110 about a pivot 4650 and, in addition, an actuation rod4660 operably coupled to the drive link 4640. The actuation rod 4660extends through an aperture defined in the longitudinal frame portion4560 and is translatable along the longitudinal axis of the shaft frame4500. The actuation rod 4660 comprises a distal end operably coupled tothe jaw assembly 8100 and a proximal end 4665 positioned in a drive slot4645 defined in the drive link 4640 such that the actuation rod 4660 istranslated longitudinally when the drive link 4640 is rotated about thepivot 4650. Notably, the proximal end 4665 is rotatably supported withinthe drive slot 4645 such that the actuation rod 4660 can rotate with theend effector 8000.

Further to the above, the actuation trigger 4610 further comprises adrive arm 4615 configured to engage and rotate the drive link 4640proximally, and translate the actuation rod 4660 proximally, when theactuation trigger 4610 is actuated, i.e., moved closer to the proximalshaft housing 4110. In such instances, the proximal rotation of thedrive link 4640 resiliently compresses a biasing member, such as a coilspring 4670, for example, positioned intermediate the drive link 4640and the frame shaft 4510. When the actuation trigger 4610 is released,the compressed coil spring 4670 re-expands and pushes the drive link4640 and the actuation rod 4660 distally to open the jaw assembly 8100of the end effector 8000. Moreover, the distal rotation of the drivelink 4640 drives, and automatically rotates, the actuation trigger 4610back into its unactuated position. That being said, the clinician couldmanually return the actuation trigger 4610 back into its unactuatedposition. In such instances, the actuation trigger 4610 could be openedslowly. In either event, the shaft assembly 4000 further comprises alock configured to releasably hold the actuation trigger 4610 in itsactuated position such that the clinician can use their hand to performanother task without the jaw assembly 8100 opening unintentionally.

In various alternative embodiments, further to the above, the actuationrod 4660 can be pushed distally to close the jaw assembly 8100. In atleast one such instance, the actuation rod 4660 is mounted directly tothe actuation trigger 4610 such that, when the actuation trigger 4610 isactuated, the actuation trigger 4610 drives the actuation rod 4660distally. Similar to the above, the actuation trigger 4610 can compressa spring when the actuation trigger 4610 is closed such that, when theactuation trigger 4610 is released, the actuation rod 4660 is pushedproximally.

Further to the above, the shaft assembly 4000 has threefunctions—opening/closing the jaw assembly of an end effector, rotatingthe end effector about a longitudinal axis, and articulating the endeffector about an articulation axis. The end effector rotation andarticulation functions of the shaft assembly 4000 are driven by themotor assembly 1600 and the control system 1800 of the drive module 1100while the jaw actuation function is manually-driven by the jaw closureactuation system 4600. The jaw closure actuation system 4600 could be amotor-driven system but, instead, the jaw closure actuation system 4600has been kept a manually-driven system such that the clinician can havea better feel for the tissue being clamped within the end effector.While motorizing the end effector rotation and actuation systemsprovides certain advantages for controlling the position of the endeffector, motorizing the jaw closure actuation system 4600 may cause theclinician to lose a tactile sense of the force being applied to thetissue and may not be able to assess whether the force is insufficientor excessive. Thus, the jaw closure actuation system 4600 ismanually-driven even though the end effector rotation and articulationsystems are motor-driven.

FIG. 553 is a logic diagram of the control system 1800 of the surgicalsystem depicted in FIG. 503 in accordance with at least one embodiment.The control system 1800 comprises a control circuit. The control circuitincludes a microcontroller 1840 comprising a processor 1820 and a memory1830. One or more sensors, such as sensors 1880, 1890, 6180′, 6280′,6380′, 7190″, and/or 6290′″, for example, provide real time feedback tothe processor 1820. The control system 1800 further comprises a motordriver 1850 configured to control the electric motor 1610 and a trackingsystem 1860 configured to determine the position of one or morelongitudinally movable components in the surgical instrument, such asthe clutches 6110, 6120, and 6130 and/or the longitudinally-movabledrive nut 7150 of the jaw assembly drive, for example. The trackingsystem 1860 is also configured to determine the position of one or morerotational components in the surgical instrument, such as the driveshaft 2530, the outer shaft 6230, and/or the articulation drive 6330,for example. The tracking system 1860 provides position information tothe processor 1820, which can be programmed or configured to, amongother things, determine the position of the clutches 6110, 6120, and6130 and the drive nut 7150 as well as the orientation of the jaws 7110and 7120. The motor driver 1850 may be an A3941 available from AllegroMicrosystems, Inc., for example; however, other motor drivers may bereadily substituted for use in the tracking system 1860. A detaileddescription of an absolute positioning system is described in U.S.Patent Application Publication No. 2017/0296213, entitled SYSTEMS ANDMETHODS FOR CONTROLLING A SURGICAL STAPLING AND CUTTING INSTRUMENT, theentire disclosure of which is hereby incorporated herein by reference.

The microcontroller 1840 may be any single core or multicore processorsuch as those known under the trade name ARM Cortex by TexasInstruments, for example. In at least one instance, the microcontroller1840 is a LM4F230H5QR ARM Cortex-M4F Processor Core, available fromTexas Instruments, for example, comprising on-chip memory of 256 KBsingle-cycle flash memory, or other non-volatile memory, up to 40 MHz, aprefetch buffer to improve performance above 40 MHz, a 32 KBsingle-cycle serial random access memory (SRAM), internal read-onlymemory (ROM) loaded with StellarisWare® software, 2 KB electricallyerasable programmable read-only memory (EEPROM), one or more pulse widthmodulation (PWM) modules and/or frequency modulation (FM) modules, oneor more quadrature encoder inputs (QEI) analog, one or more 12-bitAnalog-to-Digital Converters (ADC) with 12 analog input channels, forexample, details of which are available from the product datasheet.

In various instances, the microcontroller 1840 comprises a safetycontroller comprising two controller-based families such as TMS570 andRM4x known under the trade name Hercules ARM Cortex R4, also by TexasInstruments. The safety controller may be configured specifically forIEC 61508 and ISO 26262 safety critical applications, among others, toprovide advanced integrated safety features while delivering scalableperformance, connectivity, and memory options.

The microcontroller 1840 is programmed to perform various functions suchas precisely controlling the speed and/or position of the drive nut 7150of the jaw closure assembly, for example. The microcontroller 1840 isalso programmed to precisely control the rotational speed and positionof the end effector 7000 and the articulation speed and position of theend effector 7000. In various instances, the microcontroller 1840computes a response in the software of the microcontroller 1840. Thecomputed response is compared to a measured response of the actualsystem to obtain an “observed” response, which is used for actualfeedback decisions. The observed response is a favorable, tuned, valuethat balances the smooth, continuous nature of the simulated responsewith the measured response, which can detect outside influences on thesystem.

The motor 1610 is controlled by the motor driver 1850. In various forms,the motor 1610 is a DC brushed driving motor having a maximum rotationalspeed of approximately 25,000 RPM, for example. In other arrangements,the motor 1610 includes a brushless motor, a cordless motor, asynchronous motor, a stepper motor, or any other suitable electricmotor. The motor driver 1850 may comprise an H-bridge driver comprisingfield-effect transistors (FETs), for example. The motor driver 1850 maybe an A3941 available from Allegro Microsystems, Inc., for example. TheA3941 driver 1850 is a full-bridge controller for use with externalN-channel power metal oxide semiconductor field effect transistors(MOSFETs) specifically designed for inductive loads, such as brush DCmotors. In various instances, the driver 1850 comprises a unique chargepump regulator provides full (>10 V) gate drive for battery voltagesdown to 7 V and allows the A3941 to operate with a reduced gate drive,down to 5.5 V. A bootstrap capacitor may be employed to provide theabove-battery supply voltage required for N-channel MOSFETs. An internalcharge pump for the high-side drive allows DC (100% duty cycle)operation. The full bridge can be driven in fast or slow decay modesusing diode or synchronous rectification. In the slow decay mode,current recirculation can be through the high-side or the lowside FETs.The power FETs are protected from shoot-through by resistor adjustabledead time. Integrated diagnostics provide indication of undervoltage,overtemperature, and power bridge faults, and can be configured toprotect the power MOSFETs under most short circuit conditions. Othermotor drivers may be readily substituted.

The tracking system 1860 comprises a controlled motor drive circuitarrangement comprising one or more position sensors, such as sensors1880, 1890, 6180′, 6280′, 6380′, 7190″, and/or 6290′″, for example. Theposition sensors for an absolute positioning system provide a uniqueposition signal corresponding to the location of a displacement member.As used herein, the term displacement member is used generically torefer to any movable member of the surgical system. In variousinstances, the displacement member may be coupled to any position sensorsuitable for measuring linear displacement. Linear displacement sensorsmay include contact or non-contact displacement sensors. Lineardisplacement sensors may comprise linear variable differentialtransformers (LVDT), differential variable reluctance transducers(DVRT), a slide potentiometer, a magnetic sensing system comprising amovable magnet and a series of linearly arranged Hall Effect sensors, amagnetic sensing system comprising a fixed magnet and a series ofmovable linearly arranged Hall Effect sensors, an optical sensing systemcomprising a movable light source and a series of linearly arrangedphoto diodes or photo detectors, or an optical sensing system comprisinga fixed light source and a series of movable linearly arranged photodiodes or photo detectors, or any combination thereof.

The position sensors 1880, 1890, 6180′, 6280′, 6380′, 7190″, and/or6290′″, for example, may comprise any number of magnetic sensingelements, such as, for example, magnetic sensors classified according towhether they measure the total magnetic field or the vector componentsof the magnetic field. The techniques used to produce both types ofmagnetic sensors encompass many aspects of physics and electronics. Thetechnologies used for magnetic field sensing include search coil,fluxgate, optically pumped, nuclear precession, SQUID, Hall-Effect,anisotropic magnetoresistance, giant magnetoresistance, magnetic tunneljunctions, giant magnetoimpedance, magnetostrictive/piezoelectriccomposites, magnetodiode, magnetotransistor, fiber optic, magnetooptic,and microelectromechanical systems-based magnetic sensors, among others.

In various instances, one or more of the position sensors of thetracking system 1860 comprise a magnetic rotary absolute positioningsystem. Such position sensors may be implemented as an AS5055EQFTsingle-chip magnetic rotary position sensor available from AustriaMicrosystems, AG and can be interfaced with the controller 1840 toprovide an absolute positioning system. In certain instances, a positionsensor comprises a low-voltage and low-power component and includes fourHall-Effect elements in an area of the position sensor that is locatedadjacent a magnet. A high resolution ADC and a smart power managementcontroller are also provided on the chip. A CORDIC processor (forCoordinate Rotation Digital Computer), also known as the digit-by-digitmethod and Volder's algorithm, is provided to implement a simple andefficient algorithm to calculate hyperbolic and trigonometric functionsthat require only addition, subtraction, bitshift, and table lookupoperations. The angle position, alarm bits, and magnetic fieldinformation are transmitted over a standard serial communicationinterface such as an SPI interface to the controller 1840. The positionsensors can provide 12 or 14 bits of resolution, for example. Theposition sensors can be an AS5055 chip provided in a small QFN 16-pin4×4×0.85 mm package, for example.

The tracking system 1860 may comprise and/or be programmed to implementa feedback controller, such as a PID, state feedback, and adaptivecontroller. A power source converts the signal from the feedbackcontroller into a physical input to the system, in this case voltage.Other examples include pulse width modulation (PWM) and/or frequencymodulation (FM) of the voltage, current, and force. Other sensor(s) maybe provided to measure physical parameters of the physical system inaddition to position. In various instances, the other sensor(s) caninclude sensor arrangements such as those described in U.S. Pat. No.9,345,481, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM,which is hereby incorporated herein by reference in its entirety; U.S.Patent Application Publication No. 2014/0263552, entitled STAPLECARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, which is hereby incorporatedherein by reference in its entirety; and U.S. patent application Ser.No. 15/628,175, entitled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTORVELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT, which is herebyincorporated herein by reference in its entirety. In a digital signalprocessing system, absolute positioning system is coupled to a digitaldata acquisition system where the output of the absolute positioningsystem will have finite resolution and sampling frequency. The absolutepositioning system may comprise a compare and combine circuit to combinea computed response with a measured response using algorithms such asweighted average and theoretical control loop that drives the computedresponse towards the measured response. The computed response of thephysical system takes into account properties like mass, inertial,viscous friction, inductance resistance, etc., to predict what thestates and outputs of the physical system will be by knowing the input.

The absolute positioning system provides an absolute position of thedisplacement member upon power up of the instrument without retractingor advancing the displacement member to a reset (zero or home) positionas may be required with conventional rotary encoders that merely countthe number of steps forwards or backwards that the motor 1610 has takento infer the position of a device actuator, drive bar, knife, and thelike.

A sensor 1880 comprising a strain gage or a micro-strain gage, forexample, is configured to measure one or more parameters of the endeffector, such as, for example, the strain experienced by the jaws 7110and 7120 during a clamping operation. The measured strain is convertedto a digital signal and provided to the processor 1820. In addition toor in lieu of the sensor 1880, a sensor 1890 comprising a load sensor,for example, can measure the closure force applied by the closure drivesystem to the jaws 7110 and 7120. In various instances, a current sensor1870 can be employed to measure the current drawn by the motor 1610. Theforce required to clamp the jaw assembly 7100 can correspond to thecurrent drawn by the motor 1610, for example. The measured force isconverted to a digital signal and provided to the processor 1820. Amagnetic field sensor can be employed to measure the thickness of thecaptured tissue. The measurement of the magnetic field sensor can alsobe converted to a digital signal and provided to the processor 1820.

The measurements of the tissue compression, the tissue thickness, and/orthe force required to close the end effector on the tissue as measuredby the sensors can be used by the controller 1840 to characterize theposition and/or speed of the movable member being tracked. In at leastone instance, a memory 1830 may store a technique, an equation, and/or alook-up table which can be employed by the controller 1840 in theassessment. In various instances, the controller 1840 can provide theuser of the surgical instrument with a choice as to the manner in whichthe surgical instrument should be operated. To this end, the display1440 can display a variety of operating conditions of the instrument andcan include touch screen functionality for data input. Moreover,information displayed on the display 1440 may be overlaid with imagesacquired via the imaging modules of one or more endoscopes and/or one ormore additional surgical instruments used during the surgical procedure.

As discussed above, the drive module 1100 of the handle 1000 and/or theshaft assemblies 2000, 3000, 4000, and/or 5000, for example, attachablethereto comprise control systems. Each of the control systems cancomprise a circuit board having one or more processors and/or memorydevices. Among other things, the control systems are configured to storesensor data, for example. They are also configured to store data whichidentifies the shaft assembly to the handle 1000. Moreover, they arealso configured to store data including whether or not the shaftassembly has been previously used and/or how many times the shaftassembly has been used. This information can be obtained by the handle1000 to assess whether or not the shaft assembly is suitable for useand/or has been used less than a predetermined number of times, forexample.

Further to the above, the first module connector 1120 of the drivemodule 1100 comprises a side battery port defined in the side of thedrive module 1100. Similarly, the second module connector 1120′comprises a proximal battery port defined in the proximal end of thedrive module 1100. That said, a drive module can comprise a battery portat any suitable location. In any event, the power module 1200 isoperably attachable to the drive module 1100 at the side battery port1120, as illustrated in FIGS. 557-561 , or the proximal battery port1120′, as illustrated in FIGS. 570 and 571 . This is possible becausethe connector 1220 of the power module 1200 is compatible with the sidebattery port 1120 and the proximal battery port 1120′. Among otherthings, the connector 1220 comprises a substantially circular, orsubstantially cylindrical, configuration that matches, or at leastsubstantially matches, the substantially circular, or substantiallycylindrical, configurations of the battery ports 1120 and 1120′. Invarious instances, the connector 1220 comprises a frustoconical, or anat least substantially frustoconical, shape having a bottom portionwhich is larger than the top portion and an angled, or tapered, sideextending therebetween. The above being said, the connector 1220 of thepower module 1200 does not comprise keys, or projections, extendingtherefrom which interfere with the assembly of the power module 1200 tothe battery ports 1120 and 1120′.

Referring primarily to FIGS. 558 and 559 , the connector 1220 comprisestwo latches 1240 extending therefrom. The latches 1240 are positioned onopposite sides of the connector 1220 such that they comprise opposinglatch shoulders which releasably hold the power module 1200 to thehandle module 1100. The side battery port 1120 comprises latch openings1125 defined in the housing 1100 which are configured to receive thelatches 1240 of the power module 1200 and, similarly, the proximalbattery port 1120′ comprises latch openings 1125′ defined in the housing1100 which are also configured to receive the latches 1240 of the powermodule 1200. While the latch openings 1125 in the side battery port 1120and the latch openings 1125′ in the proximal battery port 1120′ limitthe orientations in which the power module 1200 can be assembled to eachbattery port 1120 and 1120′, i.e., two orientations for each batteryport, the power module 1200 is nonetheless operably attachable to bothbattery ports 1120 and 1120′.

Further to the above, the latches 1240 of the power module 1200 areconfigured to engage the drive module 1100 in a snap-fit manner. Invarious instances, the latches 1240 resiliently flex radially outwardlywhen the power module 1200 is assembled to the drive module 1100 andthen resiliently move, or snap, radially inwardly once the power module1200 is fully seated within one of the ports 1120 and 1120′ to lock thepower module 1200 to the drive module 1100. In various instances, thelatches 1240 comprise flexible arms which deflect radially inwardly andoutwardly as described above while, in some instances, the latches 1240comprise one or more biasing members, such as springs, for example,configured to resiliently push the latches 1240 into their inward, orlocked, positions. In various embodiments, the power module 1200 cancomprise members which are press-fit into apertures defined in the ports1120 and 1120′ to retain the power module 1200 to the drive module 1100.

Further to the above, the electrical contacts of the power module 1200are defined on the top portion, or face, of the connector 1220. Asdiscussed above, the electrical contacts of the power module 1200 engagecorresponding electrical contacts defined in the ports 1120 and 1120′when the power module 1200 is attached to the drive module 1100 to placethe power module 1200 in electrical communication with the drive module1100. In various instances, the electrical contacts of the power module1200 are compressed against the electrical contacts of the drive module1100 when the power module 1200 is attached to the drive module 1100. Inat least one such instance, the power module contacts and/or the drivemodule contacts comprise resilient members which are configured toelastically deflect when the power module 1200 is attached to the drivemodule 1100. Such resilient members, along with the latches 1240, canassure that there is an adequate electrical interface between the powermodule 1200 and the drive module 1100. In alternative embodiments, thepower module 1200 can comprise annular electrical contacts extendingaround the perimeter thereof which engage electrical contacts on thesides of the ports 1120 and 1120′. Such an arrangement could permitrelative rotation between the power module 1200 and the drive module1100.

Further to the above, the power module 1300 is operably attachable tothe drive module 1100 at the proximal battery port 1120′, as illustratedin FIGS. 562-569 , but not the side battery port 1120, as illustrated inFIGS. 572 and 573 . This is the case because the connector 1320 of thepower module 1300 is compatible with the proximal battery port 1120′,but not the side battery port 1120. Although the connector 1320comprises a substantially circular, or substantially cylindrical,configuration that matches, or at least substantially matches, thesubstantially circular, or substantially cylindrical, configurations ofthe battery ports 1120 and 1120′, the connector 1320 of the power module1300 comprises keys, or projections, 1315 extending therefrom whichinterfere with the assembly of the power module 1300 to the side batteryport 1120, but not the proximal battery port 1120′. When a clinicianattempts to assembly the power module 1300 to the side battery port1120′, the projections 1315 contact the housing 1110 and prevent thelatches 1340 of the power module 1300 from locking the power module 1300to the drive module 1100 and prevent the power module 1300 from beingelectrically coupled to the drive module 1100. That being said,referring primarily to FIGS. 566 and 567, the proximal battery port1120′ comprises clearance apertures 1115′ defined therein configured toreceive the projections 1315 of the power module 1300 and permit thepower module 1300 to be assembled to the proximal battery port 1120′.Similar to the above, the latch openings 1125′ and the clearanceapertures 1115′ in the proximal battery port 1120′ limit theorientations in which the power module 1300 can be assembled to theproximal battery port 1120′ to two orientations.

Further to the above, other circumstances can prevent the attachment ofa power module to one of the battery ports 1120 and 1120′. For instance,one of the battery ports can have an asymmetrical geometry which isconfigured to receive a complementary geometry of only one of the powermodules. In at least one such instance, the side battery port 1120 cancomprise a semicircular cavity and the proximal battery port 1120′ cancomprise a circular cavity, wherein the connector 1220 of the powermodule 1200 comprises a semicircular geometry which can be received inboth of the battery ports 1120 and 1120′ while the connector 1320 of thepower module 1300 comprises a circular geometry which can be received inthe proximal battery port 1120′, but not the side battery port 1120. Insome instances, the configuration of the shaft assembly attached to thedrive module 1100 can prevent the assembly of one of the power modulesto the drive module 1100. For instance, referring to FIG. 562 , theshaft assembly 4000, for example, can prevent the assembly of the powermodule 1300 to the side battery port 1120 as the actuation trigger 4610interferes with its assembly thereto. Notably, such an arrangement wouldalso prevent the power module 1200 from being assembled to the sidebattery port 1120. As a result, the clinician would be required to usethe proximal battery port 1120′ to couple a power module to the drivemodule 1100 when using the shaft assembly 4000. The configuration ofcertain shaft assemblies, referring to FIGS. 574 and 575 , would permitboth of the power modules 1200 and 1300 to be assembled to the drivemodule 1100 at the same time. For instance, referring to FIG. 554 , theshaft assembly 3000 of FIG. 503 would permit both of the power modules1200 and 1300 to be used to supply power to the drive module 1100simultaneously.

The power modules 1200 and 1300 are configured to supply power to thedrive module 1100 at the same, or at least substantially the same,voltage. For instance, each power module 1200 and 1300 is configured tosupply power to the drive module 1100 at 3 VDC, for example. The controlsystem 1800 of the drive module 1100 comprises one or more powerinverters, for example, configured to convert the DC current to ACcurrent to the extent that AC current is needed. That said, the powermodules 1200 and 1300 can be configured to deliver power to the drivemodule 1100 at any suitable voltage. In at least one instance, the powermodules 1200 and/or 1300 are configured to deliver AC power to the drivemodule. In at least one such instance, the power modules 1200 and/or1300 each comprise one or more power inverters. In alternativeembodiments, the power modules 1200 and 1300 are configured to supplypower to the drive module 1100 at different voltages. In suchembodiments, the configurations of the ports 1120 and 1120′, discussedabove, can prevent a power module having a higher voltage from beingattached to a lower voltage port. Likewise, the configurations of theports 1120 and 1120′ can prevent a power module having a lower voltagefrom being attached to a higher voltage port, if desired.

In various instances, the power modules 1200 and 1300 are configured toprovide the same, or at least substantially the same, current to thedrive module. In at least one instance, the power modules 1200 and 1300supply the same, or at least substantially the same, magnitude ofcurrent to the drive module 1100. In alternative embodiments, the powermodules 1200 and 1300 are configured to provide different currents tothe drive module 1100. In at least one instance, the power module 1200provides a current to the drive module 1100 having a magnitude which istwice that of the current provided by the power module 1300, forexample. In at least one such instance, the battery cells of the powermodule 1200 are arranged in parallel to provide the same voltage as thepower module 1300 but at twice the current. Similar to the above, theconfigurations of the ports 1120 and 1120′, discussed above, can preventa power module having a higher current from being attached to a lowercurrent port. Likewise, the configurations of the ports 1120 and 1120′can prevent a power module having a lower current from being attached toa higher current port, if desired.

Further to the above, the control system 1800 is configured toadaptively manage the power provided by the power modules 1200 and 1300.In various instances, the control system 1800 comprises one or moretransformer circuits configured to step up and/or step down the voltageprovided to it by a power module. For instance, if a higher voltagepower module is attached to a lower voltage port, the control system1800 can activate, or switch on, a transformer circuit to step down thevoltage from the higher voltage power module. Similarly, if a lowervoltage power module is attached to a higher voltage port, the controlsystem 1800 can activate, or switch on, a transformer circuit to step upthe voltage from the lower voltage power module. In various embodiments,the control system 1800 is configured to switch a power module off if apower module having an inappropriate voltage is attached to a port inthe drive module 1100. In at least one instance, the control system 1800comprises one or more voltmeter circuits configured to evaluate thevoltage of a power module attached to the drive module and, if thevoltage of the power module is incorrect or outside of an appropriatevoltage range, the control system 1800 can switch off the power modulesuch that the power module does not supply power to the drive module1100. In at least one such instance, the drive module 1100 has avoltmeter circuit for each port 1120 and 1120′. In at least oneinstance, the control system 1800 comprises one or more ammeter circuitsconfigured to evaluate the current of a power module attached to thedrive module and, if the current of the power module is incorrect oroutside of an appropriate current range, the control system 1800 canswitch off the power module such that the power module does not supplypower to the drive module 1100. In at least one such instance, the drivemodule 1100 has an ammeter circuit for each port 1120 and 1120′. In atleast one instance, each power module 1200 and 1300 comprises a switchcircuit which, when opened by the control system 1800, prevents powerfrom being supplied to the drive module 1100. If a power modulecomprises the correct voltage or a voltage within an appropriate voltagerange for the port in which the power module is attached, the switchcircuit remains closed and/or is closed by the control system 1800. Inat least one such instance, the drive module 1100 has a switch circuitfor each port 1120 and 1120′.

In various instances, a power module can comprise a switch which isselectively actuatable by the clinician to prevent the power module fromsupplying power to the drive module 1100. In at least one instance, theswitch comprises a mechanical switch, for example, in the power supplycircuit of the power module. A power module that has been switched off,however, can still provide other benefits. For instance, a switched-offpower module 1200 can still provide a pistol grip and a switched-offpower module 1300 can still provide a wand grip. Moreover, in someinstances, a switched-off power module can provide a power reserve thatcan be selectively actuated by the clinician.

In addition to or in lieu of the above, each of the power modules 1200and 1300 comprises an identification memory device. The identificationmemory devices can comprise a solid state chip, for example, having datastored thereon which can be accessed by and/or transmitted to thecontrol system 1800 when a power module is assembled to the drive module1100. In at least one instance, the data stored on the identificationmemory device can comprise data regarding the voltage that the powermodule is configured to supply to the drive module 1100, for example.

Further to the above, each of the shaft assemblies 2000, 3000, 4000,and/or 5000 comprise an identification memory device, such as memorydevice 2830, for example. The identification memory device of a shaftassembly can comprise a solid state chip, for example, having datastored thereon which can be accessed by and/or transmitted to thecontrol system 1800 when the shaft assembly is assembled to the drivemodule 1100. In at least one instance, the data stored on theidentification memory device can comprise data regarding the powerrequired to operate the drive systems of the shaft assembly. The shaftassembly 2000 comprises three systems driven by the drive module1100—the end effector articulation drive system, the end effectorrotation drive system, and the jaw drive system—each of which havingtheir own power requirement. The jaw drive system, for instance, mayrequire more power than the end effector articulation and rotation drivesystems. To this end, the control system 1800 is configured to verifythat the power provided by the power module, or power modules, attachedto the drive module 1100 is sufficient to power all of the drivesystems—including the jaw drive system—of the shaft assembly 2000assembled to the drive module 1100. As such, the control system 1800 isconfigured to assure that the power module arrangement attached to thedrive module 1100 is properly paired with the shaft assembly attached tothe drive module 1100. If the power provided by the power modulearrangement is insufficient, or below a required power threshold, thecontrol system 1800 can inform the clinician that a different and/or anadditional power module is required. In at least one instance, the drivemodule 1100 comprises a low-power indicator on the housing 1110 and/oron the display screen 1440, for example. Notably, the jaw drive systemof the shaft assembly 4000 is not driven by the drive module 1100;rather, it is manually powered by the clinician. As such, the powerrequired to operate the shaft assembly 4000 can be less than the powerrequired to operate the shaft assembly 2000, for example, and thecontrol system 1800 can lower the required power threshold for the shaftassembly 4000 when evaluating the power module arrangement.

Further to the above, an end effector configured to grasp and/or dissecttissue may require less power than an end effector configured to clipthe tissue of a patient. As a result, an end effector and/or shaftassembly comprising a clip applier may have a larger power requirementthan an end effector and/or shaft assembly comprising grasping and/ordissecting jaws. In such instances, the control system 1800 of the drivemodule 1100 is configured to verify that the power module, or modules,attached to the drive module 1100 can provide sufficient power to thedrive module 1100. The control system 1800 can be configured tointerrogate the identification chips on the power modules attached tothe drive module 1100 and/or evaluate the power sources within the powermodules to assess whether the power modules comprisesufficiently-available voltage and/or current to properly power thedrive module 1100 to operate the clip applier.

Further to the above, an end effector configured to grasp and/or dissecttissue may require less power than an end effector configured to suturethe tissue of a patient, for example. As a result, an end effectorand/or shaft assembly comprising a suturing device may have a largerpower requirement than an end effector and/or shaft assembly comprisinggrasping and/or dissecting jaws. In such instances, the control system1800 of the drive module 1100 is configured to verify that the powermodule, or modules, attached to the drive module 1100 can providesufficient power to the drive module 1100 based on the shaft assemblyattached to the drive module 1100. The control system 1800 can beconfigured to interrogate the identification chips on the power modulesattached to the drive module 1100 and/or evaluate the power sourceswithin the power modules to assess whether the power modules comprisesufficiently-available voltage and/or current to properly power thedrive module 1100 to operate the suturing device.

In addition to or in lieu of the above, an end effector, such as endeffector 7000, for example, comprises an identification memory device.The identification memory device of an end effector can comprise a solidstate chip, for example, having data stored thereon which can beaccessed by and/or transmitted to the control system 1800 when the endeffector is assembled to the drive module 1100 by way of a shaftassembly. In at least one instance, the data stored on theidentification memory device can comprise data regarding the powerrequired to operate the drive systems of the end effector. The endeffector can be in communication with the drive module 1100 throughelectrical pathways, or circuits, extending through the shaft assembly.Similar to the above, the end effector can identify itself to the drivemodule 1100 and, with this information, the drive module 1100 can adaptits operation to properly operate the end effector.

As described above, the power modules 1200 and 1300 each comprise one ormore battery cells. That said, the power modules 1200 and 1300 cancomprise any suitable means for storing and delivering power. In atleast one instance, the power modules 1200 and 1300 comprise capacitorsand/or supercapacitors configured to store energy and deliver energy tothe drive module 1100. The capacitors and/or supercapacitors can be partof the same electrical circuit as the battery cells or a differentelectrical circuit. A supercapacitor can comprise electrostaticdouble-layer capacitance and/or electrochemical pseudocapacitance, bothof which can contribute to the total capacitance of the supercapacitor.In various instances, electrostatic double-layer capacitors use carbonelectrodes or derivatives with much higher electrostatic double-layercapacitance than electrochemical pseudocapacitance, achieving separationof charge in a Helmholtz double layer at the interface between thesurface of a conductive electrode and an electrolyte. The separation ofcharge is often of the order of a few ångströms (0.3-0.8 nm), muchsmaller than in a conventional capacitor. Electrochemicalpseudocapacitors use metal oxide or conducting polymer electrodes with ahigh amount of electrochemical pseudocapacitance additional to thedouble-layer capacitance. Pseudocapacitance is achieved by Faradaicelectron charge-transfer with redox reactions, intercalation, and/orelectrosorption. Hybrid capacitors, such as a lithium-ion capacitor, forexample, could also be used which comprise electrodes with differingcharacteristics—one exhibiting mostly electrostatic capacitance and theother mostly electrochemical capacitance.

The power modules 1200 and 1300 can be rechargeable or non-rechargeable.When the power modules 1200 and 1300 are not rechargeable, they aredisposed of after a single use. In such instances, it is desirable forthe power modules 1200 and 1300 to be completely drained, or at leastsubstantially drained, of power when they are disposed of. To this end,each power module comprises a drain which is engaged, or actuated, whenthe power module is assembled to the drive module 1100. In variousinstances, the drain comprises a resistance circuit inside the powermodule that includes the battery cells. Once actuated, the drain slowlydischarges the battery cells of the power module, but at a rate whichstill permits the power module to provide sufficient power to the drivemodule 1100 during the surgical procedure. After the surgical procedureis completed, however, the drain continues to discharge the batterycells even though the power module may no longer be assembled to thedrive module 1100. As such, the drain discharges the battery cellswhether or not the power module is supplying power to, or attached to,the drive module 1100. The entire disclosures of U.S. Pat. No.8,632,525, entitled POWER CONTROL ARRANGEMENTS FOR SURGICAL INSTRUMENTSAND BATTERIES, which issued on Jan. 21, 2014, and U.S. Pat. No.9,289,212, entitled SURGICAL INSTRUMENTS AND BATTERIES FOR SURGICALINSTRUMENTS, which issued on Mar. 22, 2016, are incorporated byreference herein.

Multiple surgical instruments, including various handheld instruments,are used by a clinician during a particular surgical procedure toperform different functions. Each surgical instrument may comprisedifferent handle and/or grip configurations in addition to differentuser control mechanisms. Switching between various handheld instrumentsmay cause delay and/or discomfort, as the clinician regains control overthe surgical instrument and actuates the user control mechanism(s). Theuse of numerous powered surgical instruments may require a user toensure that, prior to the start of every surgical procedure, numerouspower sources are charged and/or functional, as power sources may varyand/or may not compatible with all powered surgical instruments.

A modular surgical instrument comprising a universal handle and powersource may provide a clinician with a sense of familiarity in using auniversal handle configuration. The modular surgical instrument isconfigured for use with numerous surgical tool attachments. Instead ofhaving to charge a plurality of different power sources, the modularsurgical instrument is configured for use with a replaceable powersource that can be discarded after each surgical procedure. Furthermore,the use of one universal handle with a plurality of surgical toolattachments may reduce the clutter and/or volume of surgical instrumentswithin the surgical arena.

FIG. 576 illustrates a portion of a modular surgical instrument 80000and FIG. 577 illustrates an electrical architecture of the modularsurgical instrument 80000. The configuration of the modular surgicalinstrument 80000 is similar in many respects to the surgical instrument1000 in FIG. 503 discussed above. The modular surgical instrument 80000comprises a plurality of modular components, including, for example: adrive module 80010, a shaft 80020, an end effector 80030, and a powersource 80040. In various instances, the drive module 80010 comprises ahandle. The drive module 80010 comprises one or more control switches80012 and a motor 80015.

The shaft 80020 comprises a control circuit 80022 configured tofacilitate communication between the modular components 80010, 80020,80030, 80040 of the surgical instrument 80000. The operation andfunctionality of the modular components 80010, 80020, 80030, 80040 ofthe surgical instrument 80000 are described in greater detail above inconnection with other surgical instruments.

In various instances, the one or more control switches 80012 correspondto the rotation actuator 1420 and the articulation actuator 1430 of theinput system 1400 as described in greater detail with respect to FIGS.509 and 510 above. As shown in FIGS. 509 and 510 , the articulationactuator 1430 comprises a first push button 1432 and a second pushbutton 1434. The first push button 1432 comprises a first switch that isclosed when the first push button 1434 is depressed. Similar in manyaspects to the articulation actuator 1430 and the rotation actuator 1420shown in FIGS. 509 and 510 , the one or more control switches 80012 maycomprise push buttons. When a user input depresses the push button, aswitch is closed that sends a signal to the control circuit 80022indicative of a user command. In various instances, a first push buttoncan initiate articulation or rotation in a first direction while asecond push button can initiate articulation or rotation in a seconddirection. The operation and functionality of these control switches80012 are described in greater detail above.

In various instances, the shaft 80020 is configured to be disposableafter being used to treat a patient. In such instances, the shaft 80020is usable more than once on the same patient. As discussed in moredetail below, the shaft 80020 comprises a processor 80024 and a memorystoring instructions for one or more control programs. The disposableshaft 80020 comprises any signal processing circuits required tointerface with the end effector 80030, the power source 80040, and/orthe drive module 80010 when the modular surgical instrument 80000 isfully configured, or assembled. The end effector 80030 comprises asensor array 80035 configured to monitor a parameter of the end effector80030. Such a sensor array 80035 can detect, for example, informationpertaining to the identity of the end effector 80030, an operatingstatus of the end effector 80030, and/or information regarding theenvironment of the surgical site, such as tissue properties, forexample. In various instances, the power source 80040 comprises areplaceable battery pack configured to be attached directly to the drivemodule 80010 to supply power to the surgical instrument 80000. The powersource 80040 comprises a battery 80042 and a display 80044. In variousinstances the display 80044 comprises a touch-sensitive display, forexample, wherein a user input is sent to the processor 80024.

In various instances, the drive module 80010 comprises a power sourceinterface for attaching the modular power source 80040 thereto. Thereplaceable connection between the power source 80040 and the drivemodule 80010 allows for a user to readily change out the power source80040 without having to disassemble a housing of the drive module 80010.The battery 80042 within the modular power source 80040 comprises aprimary cell, but can also include secondary cells. The primary cellbattery 80042 is configured to be fully charged once. In other words,the primary cell battery 80042 is configured to be discarded after eachsurgical procedure. Use of a disposable power supply may, among otherthings, provide assurance to the clinician that the battery 80042 isfully charged at the beginning of each surgical procedure.

The power source interface supplies the interconnection between thebattery 80042 and the connection of the display 80044 upon theattachment of the power source 80040 to the drive module 80010. In otherwords, no continuous circuits are present within the power source 80040until the power source 80040 is replaceably attached to the power sourceinterface on the drive module 80010. As such, the power source 80040 canbe distributed and sterilized in an uncoupled state. The ability to bein an uncoupled state permits each power source 80040 to be easilysterilized. For example, the modular power source 80040 is compatiblewith both ethylene oxide and gamma sterilization as no continuouscircuits are present in the unattached power source 80040.

Similar to the power source 80040, the drive module 80010 does not haveany continuous circuits while unattached to the shaft 80020 and thepower source 80040. For at least this reason, the drive module 80010 isable to be sterilized using any desired sterilization protocol followingeach use. In its unattached configuration, the drive module 80010 isconfigured to be tolerant of full immersion during the cleaning process.

Further to the above, the control circuit 80022 of the shaft 80020comprises a processor 80024 configured to receive a user input from theone or more control switches 80012 on the drive module 80010. The shaft80020 further comprises a motor controller 80028 configured to controlthe motor 80015 within the drive module 80010 when the shaft 80020 isassembled to the drive module 80010. In various instances, the controlcircuit 80022 further comprises a safety processor 80024 comprising twocontroller-based families such as, for example, TMS570 and RM4x knownunder the trade name Hercules ARM Cortex R4, by Texas Instruments. Thesafety processor 80026 may be configured specifically for IEC 61508 andISO 26262 safety critical applications, among others, to provideadvanced integrated safety features while delivering scalableperformance, connectivity, and memory options. The safety processor80026 is configured to be in signal communication with the processor80024 and the motor controller 80028. The motor controller 80028 isconfigured to be in signal communication with the sensor array 80035 ofthe end effector 80030 and the motor 80015 within the handle 80010. Themotor controller 80028 is configured to send an electrical signal, suchas, for example, a voltage signal, indicative of the voltage (or power)to be supplied to the motor 80015. The electrical signal may bedetermined based off of, for example, user input from the one or morecontrol switches 80012, input received from the sensor array 80035, userinput from the display 80044, and/or feedback from the motor 80015. Invarious instances, the motor controller 80028 may output a PWM controlsignal to the motor 80015 in order to control the motor 80015.

The shaft 80020 further comprises a memory configured to store controlprograms which, when executed, prompt the processor to, among otherthings, command the motor controller 80028 to activate the motor 80015at a pre-determined level. The memory within the control circuit 80022of each shaft 80020 is configured to store one or more control programsto permit the modular surgical instrument 80000, when fully configured,to perform a desired function. In various instances, the shaft 80020 maycomprise a default control program for when the attached shaft 80020does not comprise a control program and/or a stored control programcannot be read or detected. Such a default control program permits themotor 80015 to be run at a minimum level to allow a clinician to performbasic functions of the modular surgical instrument 80000. In variousinstances, only basic functions of the modular surgical instrument 80000are available in the default control program and are performed in amanner that minimizes harm to the tissue in and/or surrounding thesurgical site. Storing control program(s) specific to an intendedfunction in each replaceable shaft 80020 minimizes the amount ofinformation that needs to be stored and, thus, relieves the drive module80010 of the burden of storing all possible control programs, many ofwhich go unused. In various instances, the modular components 80010,80020, 80030, 80040 of the surgical instrument 80000 can be designed,manufactured, programmed, and/or updated at different times and/or inaccordance with different software and/or firmware revisions andupdates. Furthermore, individual control programs can be updated morequickly than a collection of numerous control programs. The fasterupdate time makes it more likely that clinicians and/or assistants willupdate the control program(s) to utilize the most up-to-date program ineach surgical procedure. In various instances, the drive module 80010may not comprise any control programs. In other instances, the drivemodule 80010 may comprise a default control program as discussed above.In other words, if a clinician intends to perform a first function, theclinician may attach a first shaft comprising a stored first controlprogram to the modular surgical instrument. If the clinician intends toperform a second function that is different from the first function, theclinician may remove the first shaft from the universal drive module andattach a second shaft comprising a stored second control program to themodular surgical instrument. In various instances, if the clinicianattaches a shaft without a detectable and/or functional stored controlprogram, the drive module 80010 may comprise a memory storing a defaultcontrol program to operate the modular surgical instrument 80000 atminimum levels and/or at any suitable level of functionality. Theoperation and functionality of the stored control programs are describedin greater detail in U.S. patent application Ser. No. 14/226,133, nowU.S. Patent Application Publication No. 2015/0272557, entitled MODULARSURGICAL INSTRUMENT SYSTEM, which is incorporated by reference in itsentirety herein.

FIG. 578 depicts a drive module 80110 comprising a plurality of drivesconfigured to interact with corresponding drives in an attached shaft toproduce a desired function, such as, for example, rotation and/orarticulation of an end effector. For example, the drive module 80110comprises a rotation drive 80120 configured to rotate an end effectorupon actuation. The drive module 80110 of FIG. 578 is configured tooperate based on the type of handle attached to the modular shaft. Oneor more of the plurality of drives is decoupled when a low-functionalityhandle, such as, for example, a scissor grip handle, is attached to themodular shaft. For example, during the attachment of a low-functionalityhandle to the modular shaft, an extending lug on the low-functionalityhandle may cause the rotation drive 80120 to advance distally out ofengagement with the low-functionality handle. Such distal advancementresults in a decoupling of the rotation drive 80120 from the handle,effectively locking out the functionality of the rotation drive 80120.Upon detachment of the scissor grip handle from the modular shaft, aresilient member 80125, such as, for example, a spring, biases therotation drive 80120 proximally into its original position. In variousinstances, all of the drives are decoupled upon the attachment of thelow-functionality handle to the modular shaft. In other instances, afirst drive, such as, for example, the rotation drive 80120, may bedecoupled upon the attachment of the low-functionality handle to themodular shaft, while a second drive 80130 remains in engagement for usewith the low-functionality handle.

In various instances, the rotation drive 80120 is in communication witha manual rotation actuator, such as the rotation actuator 1420 describedin more detail above with respect to FIGS. 510, 512, and 513 . As aclinician rotates the rotation actuator, the position of the rotationactuator can be monitored. For instance, the surgical instrument cancomprise an encoder system configured to monitor the position of therotation actuator. In addition to or in lieu of the encoder system, thedrive module 80110 can comprise a sensor system configured to detect adegree of rotation of the rotation actuator. In any event, the detectedposition of the rotation actuator is communicated to a processor and amotor controller, such as processor 80024 and motor controller 80028within the shaft 80020. In various instances, the drive module 80110comprises a handle.

The processor 80024 and the motor controller 80028 are configured todrive a system of the shaft 80020 other than the system being manuallydriven by the rotation drive 80120 in response to the movement of therotation drive 80120. In at least one instance, a surgical instrumenthas a first rotation joint and a second rotation joint where therotation of the surgical instrument about the first rotation joint ismanually driven and the rotation of the surgical instrument about thesecond rotation joint is driven by an electric motor. In such aninstance, the processor 80024 can monitor the rotation of the surgicalinstrument about the first rotation joint using the encoder and rotatethe surgical instrument about the second rotation joint using the motorcontroller 80028 in order to keep the rotatable components of thesurgical instrument aligned, for example.

FIG. 579 depicts a handle 80210 prior to engagement with aninterchangeable shaft 80220. The handle 80210 is usable with severalinterchangeable shafts and can be referred to as a universal handle. Theshaft 80220 comprises a drive rod 80250 configured to mechanicallyengage a distal nut 80255 of the handle 80210. A proximal end 80251 ofthe drive rod 80250 comprises a specific geometry configured to fitwithin a recess 80256 defined in the distal end of the distal nut 80255.The recess 80256 within the distal nut 80255 comprises a geometry thatis complementary of the geometry of the proximal end 80251 of the driverod 80250. In other words, once the clinician and/or the assistant hasoriented the shaft 80220 in a manner that allows for the drive rod 80250to fit within the recess on the distal nut 80255 of the handle 80210,the interchangeable shaft 80220 is successfully aligned with theuniversal handle 80210 such that there is little, if any, relativelateral movement between the distal nut 80255 and the drive rod 80250.

In various instances, the distal end 80211 of the drive nut 80255 andthe proximal end 80223 of the drive rod 80250 comprise a plurality ofmagnetic elements 80260, 80265, 80270 configured to facilitate alignmentof the shaft 80220 with the handle 80210 in addition to or in lieu ofthe mechanical alignment system described above. The system of magneticelements 80260, 80265, 80270 allows for self-alignment of the shaft80220 with the handle 80210. In various instances, the plurality ofmagnetic elements 80260, 80265, 80270 are permanent magnets. As seen inFIG. 578 , the proximal end 80223 of the shaft 80220 comprises aplurality of magnetic elements 80260, 80265 that are orientedasymmetrically, although the magnetic elements 80260, 80265 may bearranged in any suitable manner. The magnetic elements 80260, 80265 arepositioned with opposing poles facing outward from the proximal end80223 of the shaft 80220. More specifically, the magnetic elements 80260positioned on a first portion of the shaft 80220 are positioned withtheir positive poles facing outward from the proximal end 80223, whilethe magnetic elements 80265 positioned on a second, or opposite, portionof the shaft 80220 are positioned with their negative poles facingoutward from the proximal end 80223. The distal end 80211 of the drivenut 80255 comprises a plurality of magnetic elements 80270 positionedwith their negative poles facing outward from the distal end 80211 ofthe handle 80210. Such an asymmetric pattern of magnetic elements 80260,80265 on the shaft 80220 can permit the shaft 80220 and the handle 80210to be aligned at one or more predefined locations, as described ingreater detail below. The use of magnetic elements 80260, 80265, 80270eliminates the need for a spring mechanism to shift the handle 80210 andthe shaft 80220 into predetermined positions.

Further to the above, if the clinician attempts to align the handle80210 with the shaft 80220 such that the magnetic elements 80270positioned on the handle 80210 are within the vicinity of the magneticelements 80260 positioned on a first portion of the shaft 80220, themagnetic elements 80260, 80270 produce an attractive magnetic force,thereby pulling the modular components 80210, 80220 into alignment.However, if the clinician attempts to align the handle 80210 with theshaft 80220 such that the magnetic elements 80270 positioned on thehandle 80210 are closer in vicinity to the magnetic elements 80265positioned on a second portion of the shaft 80220, a repulsive magneticforce will push the modular components 80210, 80220 apart, therebypreventing an improper connection between the handle 80210 and the shaft80220.

In certain instances, further to the above, only one stable positionwill exist between the modular components. In various instances, aplurality of magnetic elements are positioned so that their polesalternate in a repeating pattern along the outer circumferences of thedistal end of the handle 80210 and the proximal end of the shaft 80220.Such a pattern can be created in order to provide for a plurality ofstable alignment positions. The repeating pattern of magnetic elementsallows for a series of stable alignments between the shaft and thehandle, as an attractive magnetic force draws the modular components80210, 80220 together at numerous positions. In various instances, theplurality of magnetic elements are oriented in a way to create abi-stable magnetic network. Such a bi-stable network ensures that themodular components 80210, 80220 end in a stable alignment even when themodular components 80210, 80220 are initially misaligned. In otherwords, when the handle 80210 and the shaft 80220 are misaligned, themagnetic fields created by the plurality of magnetic elements interactwith one another to initiate rotation out of the misaligned position andinto the next closest stable alignment. Thus, the repulsive magneticforce experienced by misaligned modular components 80210, 80220 assistsin transitioning the modular components 80210, 80220 into alignment. Asthe modular components 80210, 80220 are pushed apart by the repulsivemagnetic force, they rotate into an attractive magnetic field therebyaligning the handle 80210 and the shaft 80220. In various instances, therepulsive magnetic force initiates rotation of the handle with respectto the shaft and vice versa. The pattern of the orientation of themagnetic elements can direct the modular components 80210, 80220 torotate in a particular direction with respect to one another while alsopreventing rotation in the opposite direction. For example, in variousinstances, the magnetic elements are oriented in a pattern that allowsfor the shaft 80220 and the handle 80210 to achieve alignment byrotating with respect to one another only in a clockwise direction whena repulsive magnetic force is experienced. In other instances, themagnetic elements are oriented in a pattern that allows for the shaft80220 and the handle 80210 to reach alignment by rotating with respectto one another only in a counterclockwise direction when a repulsivemagnetic force is experienced. In various instances, the magneticelements can impact the speed with which the modular components arebrought into alignment. For example, magnetic elements can be arrangedbased on the strength of their magnetic fields in order to causeacceleration or deceleration into or out of alignment. While theplurality of magnetic elements 80260, 80265, 80270 are described aboveas being permanent magnets, in certain instances, the plurality ofmagnetic elements 80260, 80265, 80270 are electromagnets. In suchinstances, magnetic repulsive and attractive forces can be created byselectively energizing the plurality of magnetic elements 80260, 80265,80270.

In various instances, the handle 80210 and the shaft 80220 comprise adominant magnetic element that provides an initial attractive magneticforce, wherein the dominant magnetic elements are configured to pull themodular components 80210, 80220 closer together. After the modularcomponents 80210, 80220 are drawn together by the dominant magneticelements, the plurality of magnetic elements 80260, 80265, 80270 areconfigured to finely adjust the orientations of the handle 80210 and theshaft 80220.

FIG. 580 depicts a universal handle 80310 prior to being aligned withand attached to a shaft 80320. The proximal end 80323 of the shaft 80320comprises a pin 80322 configured to engage an L-shaped, or bayonet, slot80312 cut into the distal end 80311 of the handle 80310. In variousinstances, a plurality of L-shaped slots 80312 may be cut around thecircumference of the distal end 80311 to provide additional attachmentsupport for additional pins 80322. The proximal end 80323 of the shaft80320 further comprises a frame and a shaft magnetic element 80324positioned in the frame with its positive pole facing outward. Thedistal end 80311 of the handle 80310 further comprises a first magneticelement 80314 and a second magnetic element 80316. The first magneticelement 80314 is oriented with its positive pole facing outwardly, andthe second magnetic element 80316 is oriented with its negative polefacing outwardly. As the clinician begins aligning the pin 80322 of theshaft 80320 with its corresponding L-shaped slot 80312 in the handle80310, the first magnetic element 80314 and the shaft magnetic element80324 interact to produce a repulsive magnetic force. The clinician mustovercome this force in order to engage the pin 80322 with the L-shapedslot 80312. Once the pin 80322 is within the L-shaped slot 80312 and/oronce the shaft magnetic element 80324 is moved past a threshold distancewith respect to the first magnetic element and the second magneticelement 80314 and 80324, the clinician can begin to manually rotate themodular components 80310, 80320 with respect to one another. Inaddition, as shown in FIG. 581 , once the clinician has overcome therepulsive magnetic force to position the pin 80322 within the L-shapedslot 80312, the magnetic elements 80324, 80316 can react to create anattractive magnetic force once the shaft magnetic element 80324 is pastthe threshold. The attractive magnetic force results in rotation of theshaft 80320 with respect to the handle 80310 and full engagement of thepin 80322 into the L-shaped slot 80312. In such instances, theinteraction between the magnetic fields of the shaft magnetic element80324 and the second magnetic element 80316 on the handle 80310 isstrong enough to pull and/or hold the modular components 80310, 80320together. In various instances, such interaction results in anattractive magnetic force between the shaft magnetic element 80324 andthe second magnetic element 80316, resulting in alignment of the modularcomponents 80310, 80320 and full engagement of the pin 80322 within theL-shaped slot 80312. While the orientations of the magnetic elements arespecifically described, it is envisioned that the magnetic elements canbe oriented in any suitable manner. While the plurality of magneticelements 80314, 80316, 80324 are described above as being permanentmagnets, in certain instances, the plurality of magnetic elements 80314,80316, 80324 are electromagnets. In such instances, magnetic repulsiveand attractive forces can be created by selectively energizing theplurality of magnetic elements 80314, 80316, 80324.

The magnetic elements described above can comprise electromagnets,permanent magnets, or a combination thereof. In instances, such as thosedescribed above, a system of permanent magnetic elements may align theshaft and the handle in a plurality of positions. In such instances, anelectromagnet can be added to the system of permanent magnetic elements.When activated, the electromagnet is configured to exert a strongermagnetic field than the magnetic fields within the system of permanentmagnetic elements. In other words, an electromagnet may be incorporatedin order to interrupt, thwart, and/or change the cooperation between thesystem of permanent magnets. Such an interruption results in the abilityto exert selective control over the alignment of the modular componentsof the surgical instrument. For example, when a system of magneticelements, such as the magnetic elements 80260, 80265, 82070 in FIG. 579, have drawn the shaft 80220 and the handle 80210 together in a suitablyaligned position, a clinician may selectively activate an electromagnetto produce a magnetic field strong enough to overcome the attractivemagnetic forces of the permanent magnets and repel the shaft away fromthe handle. In various instances, activation of the electromagnet repelsthe handle away from the shaft to release or unlock the shaft from thehandle. In various instances, the activation of the electromagnet isconfigured to not only disrupt the attraction created by the permanentmagnets but also to decouple the modular components 80210, 80220.

A modular surgical instrument, such as the surgical instrument 80000shown in FIG. 576 , for example, comprises a plurality of componentsconfigured to communicate with one another in order to perform anintended function of the surgical instrument. The communication pathwaysbetween the components of the modular surgical instrument are describedin detail above. While such communication pathways can be wireless innature, wired connections are also suitable. In various instances, theend effector and/or shaft of the surgical instrument are configured tobe inserted into a patient through a trocar, or cannula, and can haveany suitable diameter, such as approximately 5 mm, 8 mm, and/or 12 mm,for example. In addition to size constraints, various modular surgicalinstruments, such as, for example, a clip applier, comprise endeffectors and/or shafts that are configured to rotate and/or articulate,for example. Thus, any wired communication pathway must be compact andhave flexibility in order to maintain functionality as the end effectorand/or shaft is rotated and/or articulated. In an effort to reduce thesize of operational elements within a shaft and/or end effector of asurgical instrument, various micro electro-mechanical functionalelements may be utilized. Incorporating micro-electronics such as, forexample, a piezo inchworm actuator or a squiggle motor into a surgicalinstrument assists in reducing the space needed for operationalelements, as a squiggle motor, for example, is configured to deliverlinear movement without gears or cams.

In various instances, flexibility is built into the wired communicationpathway(s) by mounting various electrical traces on a flexiblesubstrate. In various instances, the electrical traces are supported onthe flexible substrate in any suitable manner. FIG. 582 depicts a flexcircuit 80400 for use in a modular surgical instrument, such as thesurgical instrument 1000, for example. The flex circuit 80400 isconfigured to extend within a housing of a shaft, such as the shaft80020 of FIG. 576 . A distal end 80401 of the flex circuit 80400 isconfigured to be electrically coupled with conductive electrical traceswithin an end effector. In at least one instance, the electrical tracesare comprised of copper and/or silver, for example. The distal end 80401is wrapped into a first ring 80402, and the electrical traces 80405extend around the first ring 80402. A proximal end 80403 of the flexcircuit 80400 is configured to be electrically coupled with electricaltraces within a handle. The proximal end 80403 is wrapped into a secondring 80404, and the electrical traces 80405 extend around the secondring 80404.

While supporting various electrical traces on the flexible substrateprovides for flexibility, additional features may be added to, amongother things, increase the longevity of and/or protect the integrity ofthe flex circuit 80400. As depicted in FIGS. 582 and 583 , a primarystrain relief region 80410 is configured to be positioned proximally toan articulation joint. The primary strain relief region 80410 of theflex circuit 80400 experiences the most displacement and/or twisting inresponse to articulation of the surgical instrument. In an effort to,for example, relieve the strain on the flex circuit 80400 while thesurgical instrument is articulated and/or assist the portion of the flexcircuit 80400 within the primary strain relief region 80410 to return toits original orientation after the surgical instrument is unarticulated,one or more biasing and/or resilient members 80412 are present forresiliency and/or flexibility. The one or more biasing members 80412 areconfigured to transition between a flexed state and an un-flexed state,as the surgical instrument is articulated and/or rotated. In variousinstances, the biasing members 80412 comprise springs. The biasingmembers 80412 are incorporated into the substrate of the flex circuit80400 in an effort to, for example, accommodate for motions ofsurrounding parts. The portion of the flex circuit 80400 within theprimary strain relief region 80410 comprises a pattern comprising afirst leg 80414, a base 80416, and a second leg 80418. The base 80416extends between the first leg 80414 and the second leg 80418. Thebiasing member 80412 extends between and connects the first leg 80414and the second leg 80418. The biasing member 80412, among other things,permits the first leg 80414 to be deflected relative to the second leg80418 and then resiliently returns to its unflexed state. The biasingmember 80412 is configured to flex into the flexed state when an endeffector is articulated, and the biasing member 80412 is configured toresiliently return to the un-flexed state when the end effector is nolonger articulated.

As seen in FIGS. 582 and 584 , the flex circuit 80400 is manufacturedwith a secondary strain relief region 80420 whose conductive elements80405 are separate and not interconnected. Such orientation of theconductive elements 80405 allows for the flex circuit 80400 to befolded. The non-fatiguing and flexible portions of the flex circuit80400 are positioned perpendicular to the flex circuit 80400 within theprimary strain relief region 80410. The secondary strain relief region80420 comprises one or more biasing members 80422, similar to thebiasing members 80412 described in greater detail above. The presence ofbiasing members 80412 within the primary strain relief region 80410 andthe biasing members 80422 within the secondary strain relief portion80320 allows the flex circuit 80400 to have a stretchable portion in atleast two separate planes relative to a longitudinal axis of the shaft,such as the shaft 80020 of FIG. 576 , for example. The presence of theprimary strain relief portion 80410 in a first plane and a secondarystrain relief portion 80320 in a second plane allows for communicationbetween an end effector, a shaft assembly, and a handle of a surgicalinstrument configured to articulate the end effector, rotate the endeffector, and rotate the shaft assembly. In another instance, the flexcircuit 80400 can be manufactured flat and subsequently twisted in aportion, such as the primary strain relief region 80410, whichcorrelates to the articulating or actuating portion of the surgicalinstrument. Such a design may mitigate the need for stress relief of theflex circuit 80400 in general.

FIG. 585 depicts a portion of the flex circuit 80400 of FIG. 582characterized by a printed circuit board (PCB) integrally formed withthe flexible substrate 80430 of the flex circuit 80400. As shown in FIG.585 , flexible plastic is over molded onto the conductive elements 80405and various control circuit components 80432, 80434, 80436 areintegrally formed with the flexible substrate 80430 of the flex circuit80400.

FIG. 586 depicts an end effector flex circuit 80500 configured to extendwithin an end effector. The end effector flex circuit 80500 isconfigured to be used with a shaft flex circuit, such as, for example,the flex circuit 80400 shown in FIGS. 582-585 . The end effector flexcircuit 80500 comprises electrical traces 80505 supported on a flexiblesubstrate. A distal end 80503 of the end effector flex circuit 80500 iswrapped into a ring 80504. The electrical traces 80505 extend around thering 80504. As shown in FIGS. 587 and 588 , the ring 80504 is configuredto be electrically coupled with the shaft flex circuit, for example, viathe first ring 80402 on the distal end 80401 of the flex circuit 80400.One or both of the flex circuits 80400 and 80500 comprise biasingmembers to maintain electrical contact between the traces at theinterface between the flex circuits 80400, 80500. In various instances,the end effector flex circuit 80500 comprises one or more sensors, suchas, for example, a clip feed sensor 80510 and/or a clip cam form sensor80520. Such sensors can detect a parameter of the end effector andcommunicate the detected parameter to the control circuit components80432, 80434, 80436 on the shaft flex circuit 80400. In variousinstances, the control circuit is positioned within a handle of thesurgical instrument.

Referring to FIG. 589 , a surgical instrument 215000 comprises a handle215100, a shaft assembly 215500 attached to the handle 215100, an endeffector 215600, and an articulation joint 215550 rotatably connectingthe end effector 215600 to the shaft assembly 215500. The handle 215100includes a drive system 215200, a power supply 215300, and an actuator215400. The actuator 215400 is part of a closure drive configured toclose the end effector 215600. Referring to FIG. 593 , the drive system215200 comprises a first drive motor 215210, a first shifter motor215220, a second drive motor 215250, and a second shifter motor 215260.The first drive motor 215210 comprises a rotatable input shaft and aninput gear 215215 fixedly mounted to the rotatable input shaft. Thefirst shifter motor 215220 comprises a shifter shaft and a pinion gear215225 rotatably mounted to the shifter shaft. The pinion gear 215225 isoperably intermeshed with the input gear 215215 of the first drive motor215210 and is translatable between first and second positions by thefirst shifter motor 215220. When the pinion gear 215225 is in its firstposition, the pinion gear 215225 is operably intermeshed with the inputgear 215215 and an output gear 215235 fixedly mounted to a rotatableoutput shaft 215230. In such instances, the rotation of the first drivemotor 215210 is transferred to the rotatable output shaft 215230 whenthe first drive motor 215210 is operated. When the pinion gear 215225 isin its second position, the pinion gear 215225 is operably intermeshedwith the input gear 215215 and an output gear 215245 fixedly mounted toa rotatable output shaft 215240. In such instances, the rotation of thefirst drive motor 215210 is transferred to the rotatable output shaft215240 when the first drive motor 215210 is operated. Notably, thepinion gear 215225 is not engaged with the output gears 215235 and215245 at the same time and, as a result, the first drive motor 215210can be used to drive two separate functions of the surgical instrument215000. In use, a user of the surgical instrument 215000, and/or acontrol system of the surgical instrument 215000, can select between thetwo functions by shifting the first shifter motor 215220.

Further to the above, the second drive motor 215250 comprises arotatable input shaft and an input gear 215255 fixedly mounted to therotatable input shaft. The second shifter motor 215260 comprises ashifter shaft and a pinion gear 215265 rotatably mounted to the shiftershaft. The pinion gear 215265 is operably intermeshed with the inputgear 215255 of the second drive motor 215250 and is translatable betweenfirst and second positions by the second shifter motor 215260. When thepinion gear 215265 is in its first position, the pinion gear 215265 isoperably intermeshed with the input gear 215255 and an output gear215275 fixedly mounted to a rotatable output shaft 215270. In suchinstances, the rotation of the second drive motor 215250 is transferredto the rotatable output shaft 215270 when the second drive motor 215250is operated. When the pinion gear 215265 is in its second position, thepinion gear 215265 is operably intermeshed with the input gear 215255and an output gear 215285 fixedly mounted to a rotatable output shaft215280. In such instances, the rotation of the second drive motor 215250is transferred to the rotatable output shaft 215280 when the seconddrive motor 215250 is operated. Notably, the pinion gear 215265 is notengaged with the output gears 215275 and 215285 at the same time and, asa result, the second drive motor 215250 can be used to drive twoseparate functions of the surgical instrument 215000. In use, a user ofthe surgical instrument 215000, and/or a control system of the surgicalinstrument 215000, can select between the two functions by shifting thesecond shifter motor 215260.

Further to the above, referring again to FIG. 593 , the output shafts215230, 215240, and 215280 comprise rigid shafts and are concentricallynested. In various instances, a bearing is present between the outputshaft 215230 and the output shaft 215240 and another bearing is presentbetween the output shaft 215240 and the output shaft 215280. In otherinstances, the output shafts 215230, 215240, and 215280 are directlysupported by one another. Such arrangements can provide a compactdesign. In various alternative embodiments, none of the output shafts215230, 215240, and 215280 are nested.

Referring to FIG. 594 , an alternative drive system 216200 is configuredto drive a total of six functions of a surgical instrument. Similar tothe above, the drive system 216200 comprises a first drive motor 216210,a first shifter motor 216220, a second drive motor 216250, and a secondshifter motor 216260. The first drive motor 216210 comprises a rotatableinput shaft and an input gear 216215 fixedly mounted to the rotatableinput shaft. The first shifter motor 216220 comprises a shifter shaftand a pinion gear 216225 rotatably mounted to the shifter shaft. Thepinion gear 216225 is operably intermeshed with the input gear 216215 ofthe first drive motor 216210 and is translatable between first, second,and third positions by the first shifter motor 216220. When the piniongear 216225 is in its first position, the pinion gear 216225 is operablyintermeshed with the input gear 216215 and an output gear 216235 fixedlymounted to a rotatable output shaft 216230. In such instances, therotation of the first drive motor 216210 is transferred to the rotatableoutput shaft 216230 when the first drive motor 216210 is operated. Whenthe pinion gear 216225 is in its second position, the pinion gear 216225is operably intermeshed with the input gear 216215 and an output gear216245 fixedly mounted to a rotatable output shaft 216240. In suchinstances, the rotation of the first drive motor 216210 is transferredto the rotatable output shaft 216240 when the first drive motor 216210is operated. When the pinion gear 216225 is in its third position, thepinion gear 216225 is operably intermeshed with the input gear 216215and an output gear 216295 fixedly mounted to a rotatable output shaft216290. In such instances, the rotation of the first drive motor 216210is transferred to the rotatable output shaft 216290 when the first drivemotor 216210 is operated. Notably, the pinion gear 216225 is not engagedwith more than one output gear 216235, 216245, and 216295 at a time and,as a result, the first drive motor 216210 can be used to drive threeseparate functions of the surgical instrument. In use, a user of thesurgical instrument, and/or a control system of the surgical instrument,can select between the three functions by shifting the first shiftermotor 216220.

Further to the above, the output shaft 216230 is operably engaged with ashaft 216500 of the surgical instrument such that the rotation of theoutput shaft 216230 is transferred to the shaft 216500. Morespecifically, the distal end of the output shaft 216230 comprises a gearintermeshed with a ring of gear teeth 216515 defined on the interior ofthe shaft housing 216510. The output shaft 216230 is rotated in a firstdirection to rotate the shaft 216500 in one direction and an oppositedirection to rotate the shaft 216500 in another direction. The outputshaft 216240 comprises a flexible cable which can be operably coupledwith a jaw clamping drive, a firing drive system, such as a staplefiring drive and/or a tissue cutting drive, for example, and/or an endeffector rotation drive, for example. The output shaft 216290 isoperably engaged with a first articulation drive 216700. The firstarticulation drive 216700 comprises two translatable articulationdrivers 216790, each of which is coupled to a translatable drive nut216795 threadably engaged with the output shaft 216290. Each drive nut216795 comprises a pin, or projection, extending into a groove definedin the output shaft 216290 and is constrained from rotating such thatthe rotation of the output shaft 216290 translates the drive nuts216795. In use, the output shaft 216290 is rotated in a first directionto rotate an end effector of the surgical instrument about a firstarticulation joint in one direction and rotated in an opposite directionto rotate the end effector about the first articulation joint in anotherdirection. The thread defined in the output shaft 216290 is configuredto push one of the drive nuts 216795 and articulation drivers 216790distally while it pulls the other drive nut 216795 and articulationdriver 216790 proximally. That said, one drive nut and articulationdriver 216795 can be sufficient to articulate the end effector about thefirst articulation joint.

Further to the above, the second drive motor 216250 comprises arotatable input shaft and an input gear 216255 fixedly mounted to therotatable input shaft. The second shifter motor 216260 comprises ashifter shaft and a pinion gear 216265 rotatably mounted to the shiftershaft. The pinion gear 216265 is operably intermeshed with the inputgear 216255 of the second drive motor 216260 and is translatable betweenfirst, second, and third positions by the second shifter motor 216260.When the pinion gear 215665 is in its first position, the pinion gear216265 is operably intermeshed with the input gear 216255 and an outputgear 215675 fixedly mounted to a rotatable output shaft 216270. In suchinstances, the rotation of the second drive motor 216250 is transferredto the rotatable output shaft 216270. When the pinion gear 216265 is inits second position, the pinion gear 216265 is operably intermeshed withthe input gear 216255 and an output gear 216285 fixedly mounted to arotatable output shaft 216280. In such instances, the rotation of thesecond drive motor 216250 is transferred to the rotatable output shaft216280. When the pinion gear 216265 is in its third position, the piniongear 216265 is operably intermeshed with the input gear 216215 and anoutput gear 216295′ fixedly mounted to a rotatable output shaft 216290′.In such instances, the rotation of the second drive motor 216250 istransferred to the rotatable output shaft 216290′. Notably, the piniongear 216265 is not engaged with more than one output gear 216275,216285, and 216295′ at a time and, as a result, the second drive motor216250 can be used to drive three separate functions of the surgicalinstrument. In use, a user of the surgical instrument, and/or a controlsystem of the surgical instrument, can select between the threefunctions by shifting the second shifter motor 216260.

Further to the above, the output shaft 216270 and/or the output shaft216280 can be operably coupled with a jaw clamping drive, a firing drivesystem, such as a staple firing drive and/or a tissue cutting drive, forexample, and/or an end effector rotation drive, for example. The outputshaft 216290′ is operably engaged with a second articulation drive216800. The second articulation drive 216800 comprises two translatablearticulation drivers 216890, each of which is coupled to a translatabledrive nut 216895 threadably engaged with the output shaft 216290′. Eachdrive nut 216895 comprises a pin, or projection, extending into a threador groove defined in the output shaft 216290′ and is constrained fromrotating such that the rotation of the output shaft 216290′ displacesthe drive nuts 216895. In use, the output shaft 216290′ is rotated in afirst direction to rotate an end effector of the surgical instrumentabout a second articulation joint in one direction and rotated in anopposite direction to rotate the end effector about the secondarticulation joint in another direction. The thread defined in theoutput shaft 216290′ is configured to push one of the drive nuts 216895and articulation drivers 216890 distally while it pulls the other drivenut 216895 and articulation driver 216890 proximally. That said, onedrive nut and articulation driver 216895 can be sufficient to articulatethe end effector about the second articulation joint.

As outlined above, the first drive motor 216210 and the first shiftermotor 216220 are configured to drive only one of their three functionsat a time. Similarly, the second drive motor 216250 and the secondshifter motor 216260 are configured to drive only one of their threefunctions at a time. That said, the drive system 216200 is configured tooperate the first drive motor 216210 and the second drive motor 216250at the same time such that the surgical instrument can perform twofunctions simultaneously. For instance, the first drive motor 216210 canarticulate the end effector about the first articulation joint via thedrive shaft 216290 while the second drive motor 216250 can articulatethe end effector about the second articulation joint via the drive shaft216290′. Similarly, the first drive motor 216210 can rotate the shaft216500 about a longitudinal axis while the second drive motor 216250rotates the end effector about a longitudinal axis. In some instances,however, the control system of the drive system 216200 can be configuredto prevent two end effector functions from being performed at the sametime. In at least one such instance, the control system is configured toprevent the end effector from being opened while a staple firing strokeis being performed.

Further to the above, the first shifter motor 216220 can be configuredto lock out the two non-coupled drive shafts when it operably couples adrive shaft with the first drive motor 216210. In at least one suchinstance, the translatable shaft of the first shifter motor 216220 cancomprise locks defined thereon which are configured to engage and lockthe two non-coupled drive shafts in position. In at least one instance,the first shifter motor 216220 locks the drive shaft 216230 and 216240when it operably engages the first drive motor 216210 with the driveshaft 216290. Similarly, the second shifter motor 216260 can beconfigured to lock out the two non-coupled drive shafts when it operablycouples a drive shaft with the second drive motor 216250. In at leastone such instance, the translatable shaft of the second shifter motor216260 comprises locks defined thereon which are configured to engageand lock the two non-coupled drive shafts in position. In at least oneinstance, the second shifter motor 216260 locks the drive shaft 216270and 216280 when it operably engages the second drive motor 216250 withthe drive shaft 216290′. In such instances, the end effector functionsnot being driven are positively disabled, or locked out. That said,embodiments are envisioned in which the end effector functions do notneed to be locked out when they are not being used or coupled with adrive motor. In any event, the first shifter motor 216220 and/or thesecond shifter motor 216260 can comprise a solenoid, for example, tocreate the longitudinal displacement of their shafts.

As outlined above, the drive system 215200 is configured to drive fourinstrument functions and the drive system 216200 is configured to drivesix instrument functions. That said, a drive system for the instrumentsdisclosed herein can be configured to drive any suitable number offunctions, such as more than six end effector functions, for example.

Further to the above, a motor control system of a surgical instrumentcan adapt the operation of one or more motors of the surgicalinstrument. Referring to FIG. 595 , the surgical instrument 215000comprises a strain gage circuit 215900 which is in communication withthe motor control system of the surgical instrument 215000. The straingage circuit 215900 comprises a strain gage 215910 mounted to theshroud, or housing, 215510 of the shaft 215500. The strain gage 215910comprises a base 215920, a first electrical contact 215930 on the base215920, a circuitous electrical circuit 215940 in electricalcommunication with the first electrical contact 215930, and a secondelectrical contact 215950 in electrical communication with theelectrical circuit 215940. The electrical contacts 215930 and 215950 areconfigured to be soldered to, and/or otherwise electrically coupled to,conductive wires and/or traces, for example, to place the strain gage215910 in communication with the motor control system. The electricalcircuit 215940 is comprised of a thin conductive wire, the resistance ofwhich changes when the strain gage 215910 is stretched and/orcompressed, as discussed in greater detail below.

Referring again to FIG. 595 , the base 215920 of the strain gage 215910is mounted to the shroud 215510 such that the strain gage 215910elongates when the shroud 215510 is placed in tension and contracts whenthe shroud 215510 is compressed. Referring to FIG. 596 , the resistanceof the electrical circuit 215940 changes, i.e., increases, when thestrain gage 215910 is placed in tension along a longitudinal axis L,which is detectable by the motor control system. Similarly, referring toFIG. 597 , the resistance of the electrical circuit 215940 changes,i.e., decreases, when the strain gage 215910 is compressed along thelongitudinal axis L, which is also detectable by the motor controlsystem. The change in resistance of the electrical circuit 215940 isproportional, or at least substantially proportional, to the strainbeing experienced by the shroud 215510 at the location of the straingage 215910. In various instances, an increase in strain in the shaftshroud 215510 can indicate that the patient tissue is beingover-stressed in some way. With this information, the motor controlsystem of the surgical instrument 215000 can alter the performance ofthe electric motors of the surgical instrument 215000. For instance,when the strain detected by the strain gage circuit exceeds apredetermined, or threshold, value stored in the memory and/or processorof the motor control system, for example, the motor control system canslow the motor, or motors, being operated at that time. In at least onesuch instance, the motor control system can slow the electric motordriving a staple firing stroke when the strain threshold is exceeded. Inother instances, the motor control system can slow an electric motordriving a clip forming stroke or an electric motor driving a suturestroke, for example, when the strain threshold is exceeded. In variousinstances, the motor control system can slow an electric motor closingor clamping an end effector and/or articulating the end effector, forexample.

Further to the above, the motor control system of the surgicalinstrument 215000 can adaptively control the speed of one or moreelectric motors. The motor control system comprises one or more pulsewidth modulation (PWM) circuits, and/or any other suitable power controlcircuit, for controlling the speed of the electric motors. A PWM circuitis configured to apply voltage pulses to an electric motor to drive theelectric motor at a desired speed—longer voltage pulses drive theelectric motor at a faster speed and shorter voltage pulses drive theelectric motor at a slower speed. In various instances, the motorcontrol system comprises one or more frequency modulation (FM) circuitsand/or voltage transformation circuits for controlling the speed of theelectric motors. A FM circuit can apply voltage pulses to a motor at ahigher frequency to drive an electric motor at a faster speed and/or alower frequency to drive an electric motor at a slower speed. PWMcircuits and FM circuits are configured to intermittently apply avoltage potential to an electric motor at a constant, or near constant,magnitude; however, various embodiments are envisioned in which themagnitude of the voltage potential can also be changed to adjust thepower delivered by the electric motor. Variable resistance circuits, forexample, can be used to change the magnitude of the voltage applied toan electric motor.

In addition to or in lieu of adapting the voltage delivered to theelectric motors of the surgical instrument 215000 to control the speedof the motors, the current delivered to the electric motors can beadapted to control the drive force delivered by the electric motors. Tothis end, a surgical instrument can include one or more motor currentcontrol circuits.

The strain gage 215910 is an axial strain gage which is well-suited tomeasuring strain along longitudinal axis L; however, one strain gage215910 may not provide a complete understanding of the strain occurringwithin the shroud 215510. Additional strain gages positioned adjacentthe strain gage 215910 which are oriented at different directions canprovide additional data regarding the strain occurring at that position.For instance, another strain gage can be positioned orthogonally to thestrain gage 215910 along the transverse axis T and/or at a 45 degreeangle relative to the longitudinal axis L, for example. Variousembodiments are envisioned in which the more than one strain gage isprovided on a single strain gage base. Such an arrangement can provide ahigher resolution of the strain at a particular location. The abovebeing said, any suitable strain gage can be used. For instance,capacitive strain gages, semiconductor strain gages, nanoparticle straingages, and/or fiber optic strain gages, for example, could be used.

When one or more resistance strain gages are bonded to a surface tomeasure strain, as discussed above, the strain gages can be arranged ina Wheatstone bridge circuit, as illustrated in FIG. 598 . A Wheatstonebridge is a divided bridge circuit used for the measurement of static ordynamic electrical resistance. The output voltage of the Wheatstonebridge is often expressed in millivolts output per volt input. Referringto FIG. 598 , if R1, R2, R3, and R4 are equal, and a voltage, V_(IN), isapplied between points A and C, then the output between points B and Dwill show no potential difference. However, if R4 is changed to somevalue which does not equal R1, R2, and R3, the bridge will becomeunbalanced and a voltage will exist at the output terminals. In aG-bridge configuration, the variable strain sensor has resistance Rg,while the other arms are fixed value resistors.

A strain gage sensor, however, can occupy one, two, or four arms of theWheatstone bridge. The total strain, or output voltage of the circuit(V_(OUT)) is equivalent to the difference between the voltage dropacross R1 and R4, or Rg. The bridge is considered balanced whenR1/R2=Rg/R3 and, therefore, V_(OUT) equals zero. Any small change in theresistance of the sensing grid will throw the bridge out of balance,making it suitable for the detection of strain. When the bridge is setup so that Rg is the only active strain gage, a small change in Rg willresult in an output voltage from the bridge.

The number of active strain gages that should be connected to the bridgedepends on the application. For example, it may be useful to connectstrain gages that are on opposite sides of the surgical instrumenthousing or shroud, one in compression and the other in tension. In thisarrangement, the bridge output for the same strain is effectivelydoubled. In installations where all four of the arms of a Wheatstonebridge are connected to strain gages, temperature compensation isautomatic, as resistance change due to temperature variations will bethe same for all four arms of the Wheatstone bridge.

In a four-element Wheatstone bridge, further to the above, usually twogages are wired in compression and two in tension, but any suitablearrangement can be used. For example, if R1 and R3 are in tension(positive) and R2 and R4 are in compression (negative), then the outputwill be proportional to the sum of all the strains measured separately.For gages located on adjacent legs of the Wheatstone bridge, the bridgebecomes unbalanced in proportion to the difference in strain. For gageson opposite legs of the Wheatstone bridge, the bridge balances inproportion to the sum of the strains. Whether bending strain, axialstrain, shear strain, or torsional strain is being measured, the straingage arrangement will determine the relationship between the output andthe type of strain being measured. As shown in FIG. 598 , if a positivetensile strain occurs on gages R2 and R3, and a negative strain isexperienced by gages R1 and R4, the total output, V_(OUT), would be fourtimes the resistance of a single gage.

Other strain gage circuits can be used in addition to or in lieu of theWheatstone bridges discussed above. Constant current and/or constantvoltage arrangements could be used, for instance.

As outlined above, the data provided by the one or more strain gages tothe motor control system can be used to modify the operation of one ormore electric motors of the surgical instrument. In addition to or inlieu of slowing an electric motor down, the motor control system canstop an electric motor. In at least one instance, the motor controlsystem uses two or more strain thresholds in which the motor controlsystem slows the electric motor down when the measured strain exceeds afirst threshold but stops the electric motor when the measured strainexceeds a second, or higher, threshold. In certain instances, the motorcontrol system slows the electric motor down when the measured strainexceeds a first threshold and slows the electric motor down even furtherwhen the measured strain exceeds a second, or higher, threshold. Invarious instances, the motor control system can be configured to speedup an electric motor and/or restore the original speed of the electricmotor when the measured strain falls below one or more of the thresholdsit exceeded. In any event, the motor control system is configured toreceive additional data from an off-instrument surgical hub regardingdetermining the appropriate reaction to an elevated strain state.Moreover, the motor control system is configured to transmit data to thesurgical hub which can store and/or analyze the strain data and emit areturn signal regarding the appropriate reaction to an elevated strainstate. To this end, the surgical instrument 215000 comprises a wirelesssignal transmitter and a wireless signal receiver; however, hard-wiredembodiments are envisioned.

Further to the above, it should be understood that obtaining accuratestrain readings is important. That said, the environment surrounding thesurgical instrument 215000 can affect the accuracy of the strain gagereadings. Among other things, changes in the temperature of the straingage 215910 and/or the substrate underlying the strain gage 215190 canaffect the strain gage readings. To this end, the surgical instrument215000 can include a temperature control system for controlling thetemperature of the strain gage 215910. In use, the temperature controlsystem is configured to heat and/or cool the strain gage 215910 tocontrol the temperature of the strain gage 215910 relative to a desiredor predetermined temperature. In at least one embodiment, thetemperature control system comprises a resistive heating electricalcircuit to heat the strain gage 215190 and/or the substrate underlyingthe strain gage 215190. The temperature control system can include aworking fluid refrigeration circuit, such as a carbon dioxiderefrigeration circuit, for example, to cool the strain gage 215190and/or the substrate underlying the strain gage 215190. In order toassess the temperature, or temperature change, of a strain gage, thestrain gage can include a temperature sensor on the substrate of thestrain gage which is in signal communication with the motor controlsystem. Alternatively, a temperature sensor can be adjacent the straingage. In either event, the motor control system can use the data from atemperature sensor to operate the heating and/or cooling systemsdiscussed above. In addition to or in lieu of actively heating and/orcooling a strain gage, a motor control system can adjust or compensatefor the increase in temperature by adjusting the data from the straingage in view of the data received from the temperature sensor. In atleast one instance, the curve relating the voltage of the strain gage tothe strain experienced by the underlying substrate can be adjusted forchanges in the temperature of the strain gage.

In many instances, further to the above, measuring strain is anexcellent proxy for determining the forces that a surgical instrument isexperiencing. That said, such strain measurements do not directlymeasure such forces. In various embodiments, the surgical instrument215000 comprises one or more force sensors positioned adjacent to thestrain gage 215910 to directly measure the forces. In at least oneinstance, a force sensor comprises a spring element that is stretchedand/or contracted along an axis which is parallel to, or at leastsubstantially parallel to, the longitudinal axis of the strain gage215910. The force sensor is in communication with the motor controlsystem and, as a result, the motor control system can use both thestrain gage data and the force sensor data to adapt the operation of thesurgical instrument motors.

Further to the above, the strains and/or forces within the shaft shroud215510 of the surgical instrument 215500 are measurable to control theoperation of the surgical instrument 215500. In various instances,elevated strain and/or force readings in the shaft shroud 215510 suggestthat the shaft of the surgical instrument 215500 may be pressed againstthe tissue of the patient. To make the clinician aware of the forcebeing applied to the patient tissue, the surgical instrument 215500further comprises an indicator in communication with the control systemof the surgical instrument 215500 which is activated by the controlsystem when the strain measured by the strain gages and/or the forcemeasured by the force gages in the shaft shroud 215510 exceed athreshold level. The indicator can comprise a light configured to createvisible feedback, a speaker configured to create auditory feedback, avibratory motor configured to create tactile feedback, and/or an icon ona display screen, for example. In certain instances, the control systemcan reduce the speed of the motor, or motors, in the surgical instrument215500 when the strain threshold is exceeded. Controlling the electricmotors in this manner can prevent the surgical instrument 215500 fromover-deflecting and/or breaking, especially when a part of the surgicalinstrument 215500 is articulating and/or rotating, for example. In atleast one instance, the strain gages and/or force sensors can be placedon and/or in a circuit board within the surgical instrument 215500, suchas a flex circuit, for example. In such instances, as a result,excessive force loading and/or deflection within the circuitry,especially circuitry mounted to the housing of the surgical instrument,can be prevented. That said, the strains and/or forces within a movingcomponent, such as a rotatable shaft and/or translatable drive member,could also be measured. Such an arrangement allows the motor controlsystem to directly evaluate the strains and/or forces within the drivesystems of the surgical instrument 215500 and prevent the electricmotors and/or drive components from being overstressed.

The above being said, a surgical instrument can utilize a strain gage inany suitable location. In various instances, a strain gage circuit cancomprise a strain gage positioned on the jaw of an end effector. Amongother things, such a strain gage can detect the deflection of the jaw,especially when positioned at the distal end of the jaw. With such data,the motor control system can adapt the operation of the surgicalinstrument to accommodate for an over-flexed jaw, for example. In atleast one such instance, the motor control system can slow down theelectric motor used to drive a distally-movable tissue cutting knife,such as the knife of a surgical stapler, for example. In use, a jaw willdeflect elastically when tissue is captured between the jaws of the endeffector, but the jaw can sometimes deflect plastically or permanently.A strain gage positioned on the jaw will allow the motor control systemto detect that the jaw has been permanently damaged when the jaw isunclamped. If the permanent damage is above a threshold, the motorcontrol system can limit the functionality of the surgical instrument insome way and/or indicate to the user that the surgical instrument hasbecome damaged and/or indicate the degree of the damage.

Further to the above, a strain gage of a strain gage circuit can beplaced on the jaw of a surgical stapler that supports a staplecartridge. When the jaws of the surgical stapler are clamped, the straingage can detect the strain within the cartridge jaw which can reveal thedeflection of the jaw. Along these lines, the deflection of the jaw canreveal the distance between the jaws, or tissue gap. With thisinformation, the motor control system can assess the thickness of thetissue between the jaws and control the speed of the drive motor whichdrives the tissue cutting knife. For instance, the motor control systemcan slow down the drive motor when the tissue is thick and/or speed upthe drive motor when the tissue is thin. In addition to or in lieu ofthe above, a strain gage of a strain gage circuit can be placed on thetissue cutting knife. Such a strain gage can provide data relating tothe thickness and/or density of the tissue to the motor control system.Similar to the above, the motor control system can slow down the drivemotor when the tissue is dense and/or speed up the drive motor when thetissue is less dense, for example. Moreover, the motor control systemcan stop and/or pause the drive motor which closes the jaw of the endeffector when the measured strain has reached a threshold. In manyinstances, the fluid in the clamped tissue needs time to flow out of thetissue in the end effector after the end effector has been initiallyclamped and, if the strain falls back below the threshold, the motorcontrol system can be configured to re-start the closure drive motor tocompress the tissue a desired amount. Such a strain gage can be placedon one of the end effector jaws and/or the closure drive member, forexample.

The surgical instruments described herein are insertable into a patientthrough a trocar, such as the trocar 219900 illustrated in FIG. 592 . Atrocar can comprise a long shaft 219910 comprising a longitudinalaperture 219920 extending there through, a sharp distal end 219930configured to be pushed through an incision in the patient, and aproximal end 219940 comprising a sealable port or opening configured toreceive a surgical instrument S. In use, the surgical instrument ispassed through the sealable port, through the longitudinal aperture, andinto a body cavity of the patient. The sealable port comprises a sealconfigured to prevent, or at least reduce, the flow of insufflation gasfrom the patient body cavity through the trocar. The seal is configuredto bias itself into a closed, or an at least substantially closed,configuration. Even when a surgical instrument is extending through thesealable port, the seal is biased against the sides of the surgicalinstrument to create a sealed, or an at least substantially sealed,interface therebetween. In use, the trocar is orientable within theincision to permit the surgical instrument to be properly orientedwithin the body cavity. In various instances, the clinician using thesurgical instrument pushes or pulls the surgical instrument in a desireddirection to orient the surgical instrument and, in such instances, thesurgical instrument contacts the sidewalls of the longitudinal aperturewhich also orients the trocar.

In various instances, further to the above, the trocar applies forces tothe patient tissue when the trocar is oriented by the surgicalinstrument. Excessive forces can pinch, bruise, and/or otherwise damagethe tissue. To this end, a trocar can comprise one or more force sensorcircuits and/or one or more strain gage circuits configured andpositioned to detect the forces applied to the trocar by the surgicalinstrument. In various instances, a force sensor circuit is embedded ina flexible substrate, such as a ribbon, for example, positioned withinthe longitudinal aperture of the trocar. In at least one such instance,the flexible substrate extends around the inner circumference of thetrocar shaft and is attached to the trocar shaft by one or moreadhesives, for example. The force sensor circuit comprises one or moretransducers supported within the flexible substrate which are compressedby the surgical instrument when the surgical instrument is pushedagainst the trocar. A transducer, such as a piezoelectric transducer,for example, converts mechanical energy into electrical energy and, whenthe transducer is compressed between the surgical instrument and thesidewall of the trocar, the force sensor circuit generates a voltagepotential. The trocar further comprises a control system in electricaland/or signal communication with the force sensor circuits which isconfigured to detect the voltage potential, and the magnitude of thevoltage potential, created by the transducers in the force sensorcircuits.

Further to the above, the control system of the trocar uses an algorithmto determine whether the voltage potentials from the force sensorcircuits exceed one or more thresholds. The trocar further comprises atleast one haptic feedback generator, such as a light, a speaker, and/oran eccentric motor, for example, in communication with the controlsystem and, when a voltage potential form a force sensor circuit exceedsa predetermined threshold, the control system can actuate the hapticfeedback generator to indicate to the clinician that they may beapplying an excessive force to the trocar and the patient tissue via thesurgical instrument.

Further to the above, the trocar can comprise a wireless signaltransmitter in communication with the control system of the trocar. Thewireless signal transmitter is configured to emit one or more signalsincluding data regarding the force sensor circuits, especially when athreshold has been exceeded. The surgical instrument inserted throughthe trocar can comprise a wireless signal receiver in communication withthe control system of the surgical instrument which is configured toreceive the wireless signals from the trocar and relay the signals, orthe data transmitted by the signals, to the instrument control system.The surgical instrument further comprises at least one haptic feedbackgenerator, such as a light, a speaker, and/or an eccentric motor, forexample, in communication with the instrument control system and, when avoltage potential from a force sensor circuit exceeds a predeterminedthreshold, the instrument control system can actuate the haptic feedbackgenerator to indicate to the clinician that they may be applying anexcessive force to the trocar and the patient tissue via the surgicalinstrument.

Further to the above, the trocar and surgical instrument can be part ofa surgical hub system. In various instances, the trocar and the surgicalinstrument communicate with the surgical hub system instead ofcommunicating directly, as discussed above.

The force sensor circuits of the trocar can be used to assess otherinformation regarding the surgical instrument. In at least one instance,the trocar control system can determine that a surgical instrument ispresent in the trocar when the voltage potential of one or more forcesensor circuits changes. In various instances, the trocar control systemcan determine the direction in which the surgical instrument is beingpushed. When the force sensor circuits on one lateral side of the trocarchange voltage potential and the force sensor circuits on the oppositelateral side of the trocar do not change voltage potential, or have alesser voltage potential change, the trocar control system can determinethe direction in which the surgical instrument is being pushed. Incertain instances, the trocar can comprise a proximal set of transducersand a distal set of transducers which can be used to assess theorientation of the surgical instrument in the trocar. When the proximaltransducers on a first lateral side of the trocar have a higher voltagepotential than the proximal transducers on a second, or opposite, sideof the trocar and the distal transducers on the second side have ahigher voltage potential than the distal transducers on the first side,the trocar control system can determine that the surgical instrument isoriented in the second direction within the patient, for example. Suchproximal and distal transducers can also be used to assess the torquethat the surgical instrument is applying to the trocar and/or patienttissue.

Further to the above, circuits within the trocar and circuits within thesurgical instrument can be inductively coupled. In various instances,one or more trocar circuits comprise windings extending around thetrocar shaft which generate a field within the trocar which interactswith one or more circuits in the surgical instrument. In at least onesuch instance, the trocar circuits comprise copper wires embedded in thetrocar housing, for example, and the surgical instrument circuitscomprise copper wires extending through the shaft of the surgicalinstrument. In such instances, the trocar can transmit power to thesurgical instrument and/or wireless data signals to the surgicalinstrument via this inductive coupling. The trocar can have its ownpower supply and/or can receive power from the surgical hub system inthe operating room. Alternatively, the circuits of the surgicalinstrument can be configured and arranged to communicate electricalpower and/or wireless signal data to the trocar. In such instances, thesensors, control system, and/or haptic feedback generators can bepowered by the surgical instrument positioned in the trocar. In certaininstances, the trocar can enter into a low power, or sleep, mode afternot being used for a predetermined period of time. The insertion of asurgical instrument into the trocar can be detected by the trocarcontrol system via these inductive circuits which can cause the trocarto enter a full power, or wake, mode. The insertion of a surgicalinstrument into the trocar can be detected by the instrument controlsystem via these inductive circuits which can cause the instrument toenter a full power, or wake, mode.

In any event, the above-provided discussion regarding the interactionbetween a trocar and a surgical instrument is applicable to bothhand-held surgical instruments and/or surgical instruments operated by arobotic surgical system.

Referring to FIG. 599 , the surgical instrument 215000 comprises a motorcontrol system 215700. The motor control system 215700 comprises a firstcircuit board, i.e., flex circuit 215710, and, as described in greaterdetail below, a second circuit board, i.e., printed circuit board (PCB)215720. The flex circuit 215710 comprises a flexible substrate includinga non-conductive flexible base and conductive electrical traces definedwithin and/or on the non-conductive flexible base. The flex circuit215710 is contourable and is contoured to fit against the interiorsurface of the handle housing 215110. The interior surface of the handlehousing 215110 is generally concave and the flex circuit 215710 has beenflexed to match the concave configuration of the handle housing 215110;however, that said, the flex circuit 215710 is contourable to fit anysuitable configuration within the handle 215100.

The flexible base is comprised of polyimide and/or polyetheretherketone(PEEK), for example, and can comprise any suitable number of layers. Theconductive traces are comprised of copper, silver, and/or conductivepolyester, for example. The conductive traces are positioned between thelayers of the flexible base and/or embedded within the flexible base andare exposed at specific, pre-determined locations on the flex circuit215710. The exposed portions of the conductive traces are at leastpartially covered with a solder coating, such as tin and/or silver, forexample, and/or a flux coating, such as an organic flux, for example.The flex circuit 215710 further comprises electronic components mountedto the surface thereof. These surface mount electronic components aremechanically and electrically attached to the exposed portions of theconductive traces of the flex circuit 215710 via soldered connections.Surface mount electronics can be quickly assembled to the flex circuit215710 using a reflow soldering process, for example. In addition to orin lieu of the surface mount components, the flex circuit 215710 caninclude electronic components which have through-hole electricalcontacts. In such instances, the conductive traces include openings orthrough-holes which are configured to receive the electrical contacts orpins extending from the electronic devices. These pins can be solderedto the conductive traces using a reflow soldering process and/or a wavesoldering process, for example. In addition to the soldered electricalconnections, electronic components can be mechanically attached to theflexible base to reduce the possibility of the soldered connectionsbeing over-stressed.

Further to the above, the flex circuit 215710 is mounted to the handlehousing 215110 using one or more adhesives such that the bottom surfaceof the flex circuit 215710 is conformed to the handle housing 215110.The flex circuit 215710 can also be at least partially embedded in thehandle housing 215110. In at least one such instance, the handle housing215110 is comprised of plastic which is injection molded over at least aportion of the flex circuit 215710. In certain instances, conductivetraces can be directly attached to and/or embedded in the handle housing215110 without a flexible circuit board. For instance, conductive traces215760 are defined on the handle housing 215510 which are in electricalcommunication with electric contacts 215160. When the sides of thehandle housing 215110 are assembled together, the electrical contacts215160 on one side of the handle housing 215110 are electricallyconnected to corresponding electrical contacts on the other side. In anyevent, the conductive traces have portions thereof that are exposed suchthat electrical connections to the conductive traces can be made.

In use, further to the above, the power source 215300 supplies power tothe motor control system 215700. The power source 215300 comprises oneor more direct current (DC) batteries, but can comprise any suitablepower source such as an alternating current (AC) power source, forexample. The power source 215300 can comprise a voltage transformationcircuit to provide a desired voltage potential to the motor controlsystem 215700 via electrical wires, or conductors, 215750. Notably, theconductors 215750 are connected to a second circuit board 215720 of themotor control system 215700. The second circuit board 215720 comprises acard and is connected to the first circuit board 215710; however, thesecond circuit board 215720 can comprise any suitable configuration.Referring to FIG. 600 , the second circuit board 215720 is insertableinto a card slot 215120 defined in the handle housing 215110. The cardslot 215120 is configured to securely receive the second circuit board215720 such that the second circuit board 215720 does not move, or atleast substantially move, relative to the handle housing 215110 once thesecond circuit board 215720 has been inserted therein. The card slot215120 comprises electrical contacts 215130 and 215140 mounted on thewalls thereof which are in communication with the flexible circuit board215710 via conductive traces 215150. When the second circuit board215720 is seated in the card slot 215120, the electrical contacts 215130and 215140 are electrically coupled to electrical contacts 215730 and215740 on the second circuit board 215720, respectively.

Further to the above, the second circuit board 215720 comprises a cardincluding a substrate and electronic components positioned on thesubstrate. The substrate includes a printed circuit board (PCB)comprising a plurality of rigid non-conductive layers and a plurality ofconductive traces positioned intermediate and/or on the non-conductivelayers. Owing to the rigidity of the second circuit board 215720, theconductive traces can be thick and/or wide which permits the traces tocarry large electrical power loads without overheating the materials ofthe second circuit board 215720. Similar to the above, the secondcircuit board 215720 comprises surface mount electronic componentsand/or through-hole-pin electronic components mounted to andelectrically coupled to the traces—both of which are designated aselectronic components 215725. As a result of the above, the secondcircuit board 215720 is well-suited to transmit electrical loads betweenthe power source 215300 and the electric motors of the surgicalinstrument 215000 which are often quite high. As such, the first circuitboard 215710 can comprise a flex circuit which can be thinner than a PCBand better suited to transmit lower electrical power loads. That said, aflex circuit can be designed to carry any suitable electrical powerloads and can be used for any suitable application in the surgicalinstrument 215000, for example.

In view of the above, the first circuit board 215710 is designed to havelow-power circuits and transmit lower electrical power loads than thesecond circuit board 215720 which is designed to have high-powercircuits. Low-power circuits include signal circuits and/or sensorcircuits, such as circuits which are responsive to inputs on the handle215100 and/or strain gage circuits, for example. High-power circuitsinclude motor control circuits which can comprise PWM and/or FM controlcircuits, for example. Other high-power circuits include aradio-frequency (RF) generator circuit and/or a transducer drive circuitconfigured to create a standing wave in an end effector, for example.

Further to the above, the first circuit board 215710 and/or the secondcircuit board 215720 comprise memory devices configured to store dataregarding the operation, state, and/or condition of the surgicalinstrument 215000, for example. Referring to FIGS. 590 and 591 , thefirst circuit board 215710 comprises at least one data access terminaland/or contact 215170 which can be used by a clinician to access thedata stored in the memory devices. To this end, the handle housing215110 comprises an access port 215180 configured to permit a connectorand/or probe 215880 to be inserted there through to operatively connectto the data access terminal 215170. The access port 215180 comprises aseal including an elastomeric portion comprised of rubber, for example,and a sealed, but openable, aperture extending through the elastomericportion. The aperture is biased closed, or at least substantiallyclosed, by the elastomeric material of the seal and is openable topermit the probe 215880 to be inserted therethrough. When the probe215880 is withdrawn from the access port 215180, the seal can re-sealitself.

In addition to or in lieu of the above, the handle housing 215110comprises a pierceable portion which is configured to be pierced by anelectrical probe, for example. The pierceable portion can comprise athinned portion of the handle housing 215110 which can be readilypierced by the electrical probe to access the circuit boards and/ormotor control system in the handle housing 215110. In at least oneinstance, the handle housing 215110 comprises a demarcation indicatingwhere the handle housing 215110 can be pierced. In at least oneinstance, the demarcation comprises a colored zone on the handle housing215110, for example.

Referring to FIGS. 601 and 602 , a shaft assembly 215500′ is similar tothe shaft assembly 215500 in many respects. Like the shaft assembly215500, the shaft assembly 215500′ forms a rotatable interface with ahandle, such as the handle 215100, for example, that allows the shaftassembly 215500′ to rotate about a longitudinal axis. The shaft assembly215500′ comprises a flex circuit mounted to the interior of the shafthousing, or shroud, 215510′ which extends around the entirecircumference of the shaft housing 215510′ and comprises annularelectrical contacts 215520′. The handle comprises a motor control system215700′ including a printed circuit board (PCB) 215710′. The PCB 215710′comprises electrical contacts 215720′ which are engaged with and inelectrical communication with the annular electrical contacts 215520′.Each electrical contact 215720′ comprises a base seated in the PCB215710′ and a compliant or spring member biased into engagement with anannular electrical contact 215520′ such that the electrical contacts215720′ are in electrical communication with the annular electricalcontacts 215520′ regardless of the position in which the shaft assembly215500′ is rotated relative to the handle. The shaft assembly 215500′further comprises wires or conductors 215530′ which place the electricalcontacts 215520′ in electrical communication with an electric motor215200′. As a result of the above, the electric motor 215200′ in theshaft assembly 215500′ can be powered by a power source in the handle.Moreover, the interface between the electrical contacts 215520′ and215720′ can transmit signals between the shaft assembly 215500′ and thehandle. Such an arrangement can allow the motor control system in thehandle to communicate with one or more sensors, such as strain gaugesand/or force sensors, for example, in the shaft assembly 215500′, forinstance.

Referring to FIG. 603 , a handle 217100 is similar to the handle 215100in many respects. Among other things, the handle 217100 comprises ahandle housing 217110, a drive system comprising at least one electricmotor and a motor control system, a removable battery 217300 configuredto supply power to the motor control system, and an actuation trigger217400 which, when actuated, closes an end effector of the shaftassembly attached to the handle 217100. In various instances, theelectric motor is configured to drive one end effector function, such asclosing the end effector, for example. To the extent that othermotorized functions are needed, in such instances, the handle 217100 caninclude other drive motors configured to drive those other end effectorfunctions. Alternatively, a drive motor can be used to drive more thanone end effector function, as described above.

Referring again to FIG. 603 , the handle 217100 further comprisescontrols 217140, 217150, and 217160 which are in communication with themotor control system of the handle 217100. The control 217130 isactuatable to operate an electric motor in the handle 217100 whicharticulates the end effector with respect to a longitudinal axis of theshaft assembly attached to the handle 217100. Referring to FIG. 605 ,the control 217130 comprises a rocker button including a button shell217132. The rocker button shell 217132 comprises a first shell portion217131 and a second shell portion 217133 which are separated by arecessed groove 217135 defined in the rocker button shell 217132. Thecontrol 217130 further comprises a first strain gage circuit 217137attached to and/or embedded in the first shell portion 217131 and asecond strain gage circuit 217139 attached to and/or embedded in thesecond shell portion 217133. The first strain gage circuit 217137 andthe second strain gage circuit 217139 are in signal communication withthe motor control system via one or more wires or conductors 217136. Thewall of the first shell portion 217131 is configured to deflect and/ordeform when a clinician depresses the first shell portion 217131 and, insuch instances, the motor control system is configured to detect thechange in resistance in the first strain gage circuit 217137. Similarly,the wall of the second shell portion 217133 is configured to deflectand/or deform when a clinician depresses the second shell portion 217133and, in such instances, the motor control system is configured to detectthe change in resistance in the second strain gage circuit 217139. Whenthe motor control system detects an increase in resistance in the firststrain gage circuit 217137, the motor control system operates thearticulation drive motor to articulate the end effector in a firstdirection. Correspondingly, the motor control system operates thearticulation drive motor to articulate the end effector in a second, oropposite, direction when the motor control system detects an increase inresistance in the second strain gage circuit 217139. When the clinicianreleases or removes their hand from the control 217130, the button shell217132 will resiliently return to its original configuration and theresistance in the first and second strain gage circuits 217137 and217139 returns to its original state. This change in the strain gagecircuit resistance is detected by the motor control system and, at thatpoint, the motor control system stops driving the articulation drivemotor.

Further to the above, the control 217140 is also actuatable to operatethe articulation drive motor in the handle 217100. Referring to FIG. 604, the control 217140 comprises a push button including a button shell217142. The control 217140 further comprises a strain gage circuit217144 attached to and/or embedded in the button shell 217142. Thestrain gage circuit 217144 is in signal communication with the motorcontrol system via one or more wires or conductors 217146. The wall ofthe button shell 217142 is configured to deflect and/or deform when aclinician depresses the button shell 217142 and, in such instances, themotor control system is configured to detect the change in resistance inthe strain gage circuit 217144. When the motor control system detects anincrease in resistance in the strain gage circuit 217144, the motorcontrol system operates the articulation drive motor to align, of atleast substantially re-align, the end effector with the longitudinalaxis of the shaft assembly, i.e., move the end effector to a homeposition. To this end, the motor control system is configured to trackthe position of the end effector so as to know the direction and amountin which to articulate the end effector to move the end effector to itshome position. In at least one embodiment, the motor control systemcomprises an encoder, for example, to track the position of the endeffector. Once the end effector has been re-centered with thelongitudinal shaft axis, the motor control system will stop thearticulation drive motor. When the clinician releases or removes theirhand from the control 217140, the button shell 217142 will resilientlyreturn to its original configuration and the resistance in the straingage circuit 217144 will return to its original state.

Further to the above, the control 217150 is actuatable to operate afiring drive motor in the handle 217100 to perform, for example, astaple firing stroke, a clip crimping stroke, or a needle suturingstroke—depending on the type of shaft assembly attached to the handle217100. Referring to FIG. 606 , the control 217150 is positioned on theclamping actuator 217400 and comprises a push button including a buttonshell 217152. The control 217150 further comprises a strain gage circuit217154 attached to and/or embedded in the button shell 217152. Thestrain gage circuit 217154 is in signal communication with the motorcontrol system via one or more wires or conductors 217156. The wall ofthe button shell 217152 is configured to deflect and/or deform when aclinician depresses the button shell 217152 and, in such instances, themotor control system is configured to detect the change in resistance inthe strain gage circuit 217154. When the motor control system detects anincrease in resistance in the strain gage circuit 217154, the motorcontrol system operates the firing drive motor to drive a firing memberdistally. To this end, the motor control system is configured to trackthe position of the firing member so as to know when the firing memberhas reached the end of tis firing stroke and stop the firing drivemotor. In at least one embodiment, the motor control system comprises anencoder, for example, to track the position of the firing member. Inaddition to the above, the motor control system is configured to stopthe firing drive motor when the clinician releases or removes their handfrom the control 217150. In such instances, similar to the above, thebutton shell 217152 resiliently returns to its original configurationand the resistance in the strain gage circuit 217154 returns to itsoriginal state, which is detected by the motor control system.

As discussed above, the controls 217130, 217140, and 217150 aredeformable to actuate a function of the surgical instrument. To theextent that the controls 217130, 217140, and 217150 are readilydeformable, they may experience large strains which are readilydetectable by their respective strain gage circuits. Referring to FIG.608 , an actuator 217170 comprises a button shell 217172 which has oneor more living hinges 217174 defined in the walls of the button shell217172. Such living hinges 217174 can permit the button shell 217172 toreadily deform. Score marks in the button shell 217172 could also beused. In various instances, an actuator can comprise a feature whichcauses the housing of the actuator to suddenly flex, elastically snap,or give way when a force threshold has been exceeded. That said, suchreadily deformable controls may be accidentally actuated by theclinician. To this end, the motor control system can utilize one or moremeasured strain thresholds which can reduce the possibility of thesurgical instrument responding to incidental touches of the controls217130, 217140, and 217150. For instance, for strains measured by thestrain gage circuit 217144 of the actuator 217140 which are below athreshold, the motor control system will not actuate the articulationdrive motor. Correspondingly, the motor control system will actuate thearticulation drive motor for measured strains that meet or exceed thethreshold. The motor control system can also include measured strainthresholds for the other controls 217130 and 217150. The measured strainthresholds can be the same for each of the controls 217130, 217140, and217150 or they can be different. Given that different types of buttonscan deform differently, using different measured strain thresholds canbe advantageous.

Referring to FIG. 607 , further to the above, an actuator 217160comprises a solid button shell 217162. Unlike the button shell 217172,the button shell 217162 is configured such that it does notsignificantly deform when it is actuated. As a result, the motor controlsystem in communication with the strain gage circuit of the actuator217160 is configured to be responsive to much lower measured strainvalues. On the other hand, the actuator 217160 can be used to actuate animportant function of the surgical instrument and it may be desirable tohave a high measured strain threshold to prevent the accidentalactuation of the important function despite having a stiff button wallof the actuator 217160. In such instances, the clinician would have tomake a concerted effort to sufficiently depress the actuator 217160 toactuate the important function.

When an actuator is easily deformable, further to the above, theclinician should be able to readily sense that they have actuated theactuator when the wall of the actuator gives way or elasticallycollapses. When an actuator is stiff, however, a clinician may not beable to intuitively sense that the actuator has been actuated. In eitherevent, a surgical instrument can include a haptic feedback generator incommunication with the motor control system. When the motor controlsystem determines that the measured strain in an actuator strain gagecircuit has exceeded the predetermined threshold, the motor controlsystem can activate the haptic feedback generator which can notify theclinician that the actuator has been sufficiently actuated. In variousinstances, the haptic generator comprises at least one visual indicatordevice, such as a light, for example, at least one auditory indicatordevice, such as a speaker, for example, and/or at least one vibratoryindicator device, such as an electric motor with an eccentric rotationalelement, for example.

In various embodiments, further to the above, a motor control system canutilize two or more measured strain thresholds in connection with anactuator, such as the actuator 217160, for example, for determining anappropriate action of the surgical instrument. For instance, the motorcontrol system can comprise a first measured strain threshold and asecond measured strain threshold which is higher than the first strainthreshold. When the measured strain is below the first measured strainthreshold and the second measured strain threshold, the motor controlsystem does not drive the electric motor of the drive system associatedwith the actuator. When the measured strain is at or above the firstmeasured strain threshold but below the second measured strainthreshold, the motor control system actuates a first haptic feedbackgenerator, such as a first light, for example, but it does not drive theelectric motor. When the measured strain is at or above the secondmeasured strain threshold, the motor control system actuates a secondhaptic feedback generator, such as a second light, for example, anddrives the electric motor. In such instances, the clinician is providedwith a warning or notice via the first haptic feedback generator thatthey are depressing the actuator in some way, intentionally orunintentionally. When the measured strain falls below the secondmeasured strain threshold, but not the first measured strain threshold,the motor control system deactivates the second haptic feedbackgenerator, but not the first haptic feedback generator. The motorcontrol system also stops driving the electric motor in such instances.When the measured strain falls below the first measured strainthreshold, the motor control system deactivates the first hapticfeedback generator.

Further to the above, the actuators 217130 and 217140 are comprised of adifferent material than the handle housing 217110. The actuators 217130and 217140 are comprised of a first plastic material and the handlehousing 217110 is comprised of a second plastic material which isdifferent than the first plastic material. The first plastic material ismore flexible than the second plastic material so that the actuators canbe deformed to actuate the surgical instrument, as described above. Invarious instances, the first plastic material is selected such that themodulus of elasticity of the first plastic material is lower than themodulus of elasticity of the second plastic material. In any event, theactuators 217130 and 217140 are manufactured separately from the handlehousing 217110 and then assembled to the handle housing 217110. Theactuators 217130 and 217140 and the handle housing 217110 compriseco-operating features which interlock to connect the actuators 217130and 217140 to the handle housing 217110. In at least one embodiment, theactuators 217130 and 217140 are placed in a mold and the handle housing217110 is injection molded around the actuators 217130 and 217140 suchthat the button housings are held in place, yet sufficiently exposedsuch that the clinician can actuate them. Similar to the above,interlocking features between the actuators 217130 and 217140 and thehandle housing 217110 can be created during the injection moldingprocess which hold the actuators 217130 and 217140 in position relativeto the handle housing 217110. In various instances, the actuators 217130and 217140 are formed during a first shot of an injection moldingprocess and the handle housing 217110 is formed during a second shot ofthe injection molding process. These arrangements can decrease, if noteliminate, the size of the seam openings between the actuators 217130and 217140 and the handle housing 217110. The above-provided discussionalso applies to the closure actuator 217400 and the actuator 217150which, once manufactured, can be assembled to the handle housing 217110.

In various alternative embodiments, further to the above, the actuators217130 and 217140 are comprised of the same material as the handlehousing 217110. In at least one such embodiment, the actuators 217130and 217140 are thinner than the handle housing 217110 such that they cansufficiently deform to actuate the surgical instrument while the handlehousing 217110 is sufficiently rigid so as to not deform unacceptablyduring use. Similar to the above, the actuators 217130 and 217140 can bemanufactured separately from the handle housing 217110 and thenassembled to the handle housing 217110. In at least one alternativeembodiment, the actuators 217130 and 217140 are formed integrally withthe handle housing 217110. In such instances, the handle housing 217110can be formed in two halves which are assembled together by a snap-fitconnection, fasteners, and/or one or more adhesives, for example. In atleast one embodiment, the actuators 217130 and 217140 and the handlehousing 217110 are formed during an injection molding process. In suchinstances, the strain gage circuits 217134 and 217144 can be positionedin the mold before the melted plastic is injected into the mold suchthat the strain gage circuits 217134 and 217144 are at least partiallyembedded in the actuators 217130 and 217140. Otherwise, the strain gagecircuits 217134 and 217144 can be applied to the actuators 217130 and217140, respectively, after the injection molding process. Similar tothe above, the actuators 217130 and 217140 are thinner than the handlehousing 217110 such that they can sufficiently deform to actuate thesurgical instrument while the handle housing 217110 is sufficientlyrigid so as to not deform unacceptably during use. Such arrangements caneliminate the seams between the actuators 217130 and 217140 and thehandle housing 217110 and create a sealed interface between theactuators 217130 and 217140 and the handle housing 217110. Theabove-provided discussion also applies to the closure actuator 217400and the actuator 217150 which, once manufactured, can be assembled tothe handle housing 217110.

In various instances, the plastics used to form the actuators 217130 and217140 and/or the handle housing 217110 are capable of beingelectroplated. In at least one such instance, conductive traces areelectroplated directly onto the actuators 217130 and 217140 and/or thehandle housing 217110. The electroplated conductive traces can becomprised of any suitable material, such as tin and/or silver, forexample.

In various embodiments, sensors and/or switches other than strain gagescan be used to actuate the electric motors of a motor control system. Inat least one such embodiment, a handle and/or shaft of a surgicalinstrument comprises at least one actuator which is deflectable tocontact a sensor and/or switch to open and/or close a sensor circuit, asthe case may be, to actuate an electric motor of the surgicalinstrument. Similar to the above, such an actuator can comprise aseparate component which is assembled to the handle housing, forexample, and is deformable inwardly to contact a sensor and/or switch.Also similar to the above, such an actuator can comprise an integralthin portion of the handle housing which is deformable inwardly tocontact a sensor and/or switch. In either event, the sensor and/orswitch is positioned behind and aligned with the actuator and can bemounted to a circuit board, for example.

Referring again to FIG. 589 , the shaft assembly 215500 comprisesactuators 215520, 215530, and 215540 which are configured to operate inthe same or similar way as the other actuators described herein. Theactuators of the shaft assembly 215500 comprise slide rail actuators,radial actuators, rotational actuators, press-button actuators, and/orany other suitable actuators. In various instances, the shaft assembly215500 is not meant to be re-used after the surgical procedure and is,thus, disposable. In certain instances, the shaft assembly 215500 can bere-used if it has not exceeded its maximum number of permittedactuations and has been cleaned and re-sterilized. The handle 215100 canalso be disposable or re-usable.

In various alternative embodiments, an actuator can be actuated withouthaving to be deflected and/or deformed. In at least one such embodiment,the actuator comprises a capacitive sensor circuit attached to and/orembedded within the handle housing which is in signal communication withthe motor control system. The capacitive sensor circuit comprises one ormore capacitive sensors which are evaluated by the motor control systemfor changes in capacitance therein when the clinician places theirfinger on and/or over one of the capacitive sensors. When the measuredcapacitance, or capacitance change, exceeds a predetermined threshold,the motor control system actuates the electric motor of the drive systemassociated with the actuator. When the measured capacitance, orcapacitance change, falls below the predetermined threshold, the motorcontrol system no longer drives the electric motor. That said, the motorcontrol system can be configured to perform any suitable action when themeasured capacitance, or capacitance change, falls below thepredetermined threshold.

In at least one instance, further to the above, the handle housingcomprises recesses defined therein and the capacitive sensors arepositioned in the recesses. Such an arrangement allows the capacitivesensors to be flush, or at least substantially flush, with the outersurface of the handle housing. In at least one such instance, thecapacitive sensors can be a different color than the handle housing suchthat they are readily observable by the clinician.

In various instances, further to the above, an actuator comprises amembrane switch. In at least one instance, a membrane switch comprisestwo conductive plates separated by dielectric dots positioned betweenthe conductive plates. One or both of the conductive plates areconfigured to flex when the membrane switch is depressed and change theelectrical state of the membrane switch. The membrane switch can behermetically sealed so as to prevent water intrusion and/or contaminantsfrom entering the membrane switch which can unintentionally change theelectrical properties of the membrane switch.

Further to the above, an actuator can comprise a piezoelectric sensorcircuit attached to and/or embedded within the handle housing which isin signal communication with the motor control system. The piezoelectricsensor circuit comprises one or more piezoelectric sensors which areevaluated by the motor control system for changes in electricalproperties thereof when the clinician places their finger on and/or tapsone of the piezoelectric sensors. When the measured electrical property,or electrical property change, exceeds a predetermined threshold, themotor control system actuates the electric motor of the drive systemassociated with the actuator. When the measured electrical property, orelectrical property change, falls below the predetermined threshold, themotor control system no longer drives the electric motor. That said, themotor control system can be configured to perform any suitable actionwhen the measured electrical property, or electrical property change,falls below the predetermined threshold. In at least one instance, thehandle housing comprises recesses defined therein and the piezoelectricsensors are positioned in the recesses. Such an arrangement allows thepiezoelectric sensors to be flush, or at least substantially flush, withthe outer surface of the handle housing. In at least one such instance,the piezoelectric sensors can be a different color than the handlehousing such that they are readily observable by the clinician.

Referring to FIG. 609 , a handle 218100 comprises a handle housing218110, a button actuator 218140, a rotatable actuator 218400, and apositionable actuator 218800. The positionable actuator 218800 comprisesan arm 218810 which is rotatably mounted to the handle housing 218110about a pivot pin 218820 which defines a rotation axis RA. The pivot pin218820 is secured to the housing 218110 such that the positionableactuator 218800 does not translate, or at least substantially translate,relative to the housing 218110. Moreover, the pivot pin 218820 fitssnugly in an aperture in the housing 218110 such that rotating the arm218810 about the rotation axis RA requires a concerted effort on thepart of the clinician. In at least one instance, the pivot pin 218820comprises a lock screw which is loosenable to pivot the arm 218810 andtightenable to lock the arm 218810 in position. In any event, the arm218810 can be pivoted into a comfortable position for the clinician suchthat a joystick 218830 on the arm 218810 is easily accessible by theclinician. The joystick 218830 comprises one or more sensors incommunication with the motor control system of the handle 218100. Inuse, the motor control system is configured to interpret and usevoltages, currents, and/or any other data from the sensors of thejoystick 218830 to articulate the end effector of a shaft assemblyattached to the handle 218100. The end effector is articulatable in morethan one plane and can be articulatable about one or more articulatejoints by one or more motor-driven articulation drive systems.

Referring to FIG. 610 , a handle 218100′ comprises a handle housing218110′, a button actuator 218140, a rotatable actuator 218400, and apositionable actuator 218800′. The positionable actuator 218800′comprises an arm 218810′ which is rotatably mounted to the handlehousing 218110′ about a pivot pin 218820′ which defines a rotation axisRA. The pivot pin 218820′ is secured to the housing 218110′ such thatthe positionable actuator 218800′ does not translate, or at leastsubstantially translate, relative to the housing 218110′. Moreover, thepivot pin 218820′ fits snugly in an aperture in the housing 218110′ suchthat rotating the arm 218810′ about the rotation axis RA requires aconcerted effort on the part of the clinician. In at least one instance,the pivot pin 218820′ comprises a lock screw which is loosenable topivot the arm 218810′ and tightenable to lock the arm 218810′ inposition. In any event, the arm 218810′ can be pivoted into acomfortable position for the clinician such that a joystick 218830 onthe arm 218810′ is easily accessible by the clinician. For instance, thearm 218810′ is rotatable between the left and right sides of the handle218100′. The joystick 218830 comprises one or more sensors incommunication with the motor control system of the handle 218100′. Inuse, the motor control system is configured to interpret and usevoltages, currents, and/or any other data from the sensors of thejoystick 218830 to articulate the end effector of a shaft assemblyattached to the handle 218100′. The end effector is articulatable inmore than one plane and can be articulatable about one or morearticulate joints by one or more motor-driven articulation drivesystems.

Referring to FIG. 611 , a surgical instrument handle 219100 comprises ahandle housing 219110, a button actuator 218140, and a joystick 219130.Unlike the joystick 218130, the joystick 219130 is not mounted on arotatable arm and is, instead, directly mounted to the handle housing219110. The joystick 219830 comprises one or more sensors incommunication with the motor control system of the handle 219100. Inuse, the motor control system is configured to interpret and usevoltages, currents, and/or any other data from the sensors of thejoystick 219830 to articulate the end effector of a shaft assemblyattached to the handle 219100. The end effector is articulatable in morethan one plane and can be articulatable about one or more articulatejoints by one or more motor-driven articulation drive systems.

In addition to or in lieu of a joystick for controlling the articulationof the end effector, a surgical instrument can include a projectedcapacitive (PCAP) touchscreen for controlling the articulation of theend effector. A PCAP touchscreen comprises electrodes that are alignedin a grid pattern on the sensor side of a touch panel. The electrodegrid detects the touch point by sensing the change of electrical chargesthat occur when a finger of the clinician touches the surface of thetouch panel. Such a device can be used in conjunction with amicroprocessor of a motor control system which is configured tointerpret the touches and/or touch motions on the PCAP touchscreen andmove the end effector in a manner which parallels the touches and/ortouch motions. The microprocessor is configured to interpret fingertaps, finger drags, and/or rotational finger swipes, for example, on thePCAP touchscreen and articulate the end effector in an intuitive manner.For instance, the microprocessor is configured to interpret a finger tapon the PCAP touchscreen as a command to position the end effector in alocation which corresponds to where the finger tap occurred on the PCAPtouchscreen. A finger tap on the left side of the PCAP touchscreen willcause the end effector to be articulated to the left and a finger tap onthe right side of the PCAP touchscreen will cause the end effector to bearticulated to the right, for example. A finger tap on the top side ofthe PCAP touchscreen will cause the end effector to pitch down and afinger tap on the bottom side of the PCAP touchscreen will cause the endeffector to pitch up. A finger drag on the PCAP touchscreen will causethe end effector to be articulated in the direction of the finger dragand at the speed of the finger drag, for example. A leftward motionarticulates the end effector left, a rightward motion articulates theend effector right, a topward motion pitches the end effector down, anda bottomward motion pitches the end effector up. A fast finger drag willarticulate the end effector quickly and a slow finger drag willarticulate the end effector slowly. A rotational finger swipe on thePCAP touchscreen will cause the end effector to rotate about alongitudinal axis in the direction of the rotational finger swipe, forexample. A clockwise finger swipe will rotate the end effector clockwiseand a counter-clockwise finger swipe will rotate the end effectorcounter-clockwise.

Further to the above, the PCAP touchscreen can include icons thereonwhich facilitate the use of the PCAP touchscreen and suggest how thefinger motions will be interpreted by the microprocessor. A finger tapicon is depicted in FIG. 612 . A finger drag icon is depicted in FIG.613 . A rotational finger swipe is depicted in FIG. 614 . Such iconscould also be positioned on the handle housing.

A surgical theatre is often divided into a sterile field and anon-sterile field. During a surgical procedure, certain cliniciansremain in the sterile field while other clinicians remain in thenon-sterile field. Typically, surgical instruments within the sterilefield are handled by the clinicians in the sterile field. That said,instances are envisioned in which a surgical instrument comprises asterile barrier that allows a clinician, in the sterile field ornon-sterile field, to interact with the surgical instrument. In at leastone instance, the sterile barrier comprises a flexible membrane mountedto the surgical instrument. Depending on the surgical instrument and itsuse, the entirety of the surgical instrument or only a portion of thesurgical instrument is protected by the sterile barrier. In at least oneinstance, the surgical instrument comprises one or more pressuresensitive displays that can be interacted with through the sterilebarrier. In use, the surgical instrument in the sterile barrier maygenerate heat. To this end, the sterile barrier can comprise a heat sinkconfigured to extract heat from within the sterile barrier and dissipatethe heat into the surrounding environment. The heat sink can becomprised of any suitable thermally conductive material, such as copperand/or silver, for example. Silver provides an additional advantageowing to its anti-microbial properties. In at least one instance, theheat sink comprises an array of conductive traces extending within thesterile barrier. The conductive traces are embedded within, attached to,and/or printed on the sterile barrier. Such traces can promoteconductive heat transfer. In at least one instance, the conductivetraces comprise fins that extend from the sterile barrier. Such fins canpromote convective heat transfer. In various instances, the materials ofthe sterile barrier and/or conductive traces are comprised of a materialwhich promotes radiant heat transfer.

As discussed above, a surgical instrument can comprise two or morecircuit boards which are operably interconnected by one or moreelectrical connectors. In many instances, an electrical connectioncomprises two halves—a male connection half and a female connectionhalf. The male connection half comprises male electrical contacts whichcan comprise pins, for example, while the female connection halfcomprises female electrical contacts which can comprise sockets, forexample, configured to receive the pins. Each socket comprises one ormore deflectable members or tangs configured to engage a pin insertedinto the socket and establish one or more electrical contact interfacestherebetween. Even under ideal conditions, such electrical contactinterfaces create voltage drops within an electrical circuit. Moreover,an electrical contact interface can degrade over time and/or as a resultof use. For instance, the surfaces of the contact interface can oxidizeover time and, in such instances, the voltage drop across the contactinterface increases as the oxidization increases. In order to reducesuch oxidization, the pins and/or sockets can be electroplated with tin,lead, silver, and/or gold, for example. Such electroplating can compriseany suitable thickness, such as between approximately 5 μm andapproximately 100 μm, for example. Electroplating having a thickness ofapproximately 5 μm is often referred to as a “strike” of electroplatingand is often used when the plating material is expensive, such as gold,for example. A contact interface can degrade for other reasons,especially when the contact interface carries a high power load. Invarious instances, a contact interface can develop “whiskers” which growoutwardly from an electro-plated surface, especially when tin plating isused without lead intermixed therein. Such whiskers can reduce thedistance between adjacent pairs of electrical contacts and, as a result,increase the electromagnetic interference between the adjacent pairs ofelectrical contacts and/or create a short between the pairs ofelectrical contacts. That said, various metals can be introduced intothe electroplating to reduce the growth of such whiskers. In someinstances, a contact interface can develop fretting corrosion within thecontact interface as a result of thermocycling, for example. In certaininstances, one of the contact tangs can bend or yield when theelectrical connectors are engaged with one another.

In view of the above, a control circuit of a surgical instrumentcomprising one or more electrical interconnections can be configured toassess the contact quality of the electrical interconnections after thecomponents of the surgical instrument have been assembled togetherand/or during the use of the surgical instrument. The control circuit isconfigured to assess if the signal across an electrical connection isbeing distorted by the electrical connection. In at least one instance,the control circuit comprises a signal emitter configured to emit asignal through an electrical circuit including an electrical contact, asignal receiver configured to compare the return signal to the expectedreturn signal, and a digital signal processor for determining if thereis signal distortion. Any suitable algorithm can be used to assesssignal distortion, such as an algorithm that uses the root mean squareof the signal, for example. If the return signal for each of theelectrical circuits sufficiently matches their expected return signal,then the control circuit can communicate to the user of the surgicalinstrument that the signal fidelity within the surgical instrument issufficient. In at least one instance, the control circuit comprises anindicator light, such as an LED, for example, which is illuminated toindicate there is sufficient signal fidelity in the surgical instrument.If one or more of the return signals does not sufficiently match itsexpected return signal, the control circuit can communicate to the userof the surgical instrument that the signal fidelity within the surgicalinstrument may not be sufficient. In such instances, another LED couldbe illuminated and/or the signal fidelity LED can comprise a two-colorLED which can be switched from green to red, for example. In variousinstances, the control circuit is configured to use more than one signalfidelity threshold—a first threshold above which there is sufficientsignal fidelity (or an acceptable amount of noise), a second thresholdbelow the first threshold above which indicates possibly sufficientsignal fidelity (or a potentially inappropriate amount of noise), and athird threshold below the second threshold below which there isinsufficient signal fidelity (or extensive noise). When the signalfidelity of an electrical circuit is between the first and secondthresholds, the control circuit can increase the gain of the powersupplied to that circuit to improve the fidelity of the signal. In atleast one instance, the magnitude of the voltage is increased. Incertain instances, the control circuit can adjust the communicationspeed across an electrical circuit in view of the signal-noise ratio.For high signal-noise ratios, the control circuit can transmit dataacross the electrical contact interface at a high rate or with shortgaps between the data, or data packets, for example. For lowsignal-noise ratios, the control circuit can transmit data across theelectrical contact interface at a lower rate or with longer gaps betweenthe data, or data packets, for example.

In addition to or in lieu of the above, a control circuit is configuredto assess the voltage drop across an electrical contact interface. Forinstance, when the control circuit detects that a lower-than-expectedvoltage potential is being delivered to an electronic device within anelectrical circuit, for example, the control circuit can increase thegain of the power supplied to that electrical circuit. In at least onesuch instance, the magnitude of the voltage is increased, for example.To the extent that a short circuit is detected in an electrical circuit,the surgical instrument may be unusable altogether or limited in thefunctions that it can perform. To this end, the control circuit, aprocessing circuit and/or an algorithm can be utilized to decide whetheror not the short circuit is present on a critical function, whether thesurgical instrument can still be used, and what functions can still beused. Upon detecting a short circuit, in various instances, the controlcircuit can enter into a limp mode that permits only the surgicalinstrument functions that allow the surgical instrument to be removedfrom the patient and/or permits the status of the surgical instrument tobe monitored by the clinician, for example. In addition to or in lieu ofthe above, the control circuit can execute an algorithm for assessingwhether a detected short circuit is actually a short circuit. In atleast one instance, the algorithm operates to increase the gain of thesignal in the electrical circuit upon detecting a short circuit and, ifthe short circuit is still detected after increasing the gain, thecontrol circuit quickly interrupts the power to the electrical circuitcomprising the short circuit. However, if increasing the signal gainestablishes or re-establishes sufficient signal fidelity, then thecontrol circuit can continue to permit the use of that electricalcircuit.

Further to the above, the signal fidelity and/or voltage drop within anelectrical circuit can be assessed when the surgical instrumentcomponents are assembled. The electrical circuits can also be assessedwhen the surgical instrument is powered on and/or woken up from a lowpower, or sleep, mode. The electrical circuits can be assessedintermittently or continuously throughout the operation of the surgicalinstrument. In various instances, the control circuit of a surgicalinstrument can enter into a limp mode when the signal distortion and/orvoltage drop exceed a predetermined threshold. In various instances, thecontrol circuit can enter into a limp mode that permits only thesurgical instrument functions that allow the surgical instrument to beremoved from the patient and/or permits the status of the surgicalinstrument to be monitored by the clinician, for example. The controlcircuit can also try to fix the signal distortion and/or voltage drop byincreasing the signal gain, for example. When there is fluid intrusioninto an electrical interface, however, increasing the signal gain maynot resolve these issues.

In various instances, further to the above, the surgical instrument cancomprise a fan positioned to blow air across the electrical interfacewhen the signal distortion and/or voltage drop within one or moreelectrical circuits is high, or above a predetermined threshold. Invarious instances, the fan forms a part of the control circuit. In atleast one instance, the fan is positioned proximally with respect to theelectrical interface such that air is blown in a proximal-to-distaldirection, for example. In certain instances, the surgical instrumentcan be configured to at least partially insufflate the patient withcarbon dioxide, for example. In such instances, the insufflation pathcan pass over the electrical interface which can dry the electricalinterface and/or prevent fluid intrusion in the first place. The controlcircuit comprises a speed control circuit, such as a pulse widthmodulation (PWM) circuit, a frequency modulation (FM) circuit, and/or avariable-resistance circuit, for example, configured to operate the fanat different speeds. In such instances, the control circuit isconfigured to operate the fan at a higher speed when the signaldistortion and/or voltage drop is higher and at a lower speed when thesignal distortion and/or voltage drop is lower. In various instances,the patient can also be insufflated through one or more trocars, orports, extending into the patient. In such instances, the controlcircuit is configured to communicate with a surgical hub system when thefan is turned on, turned off, accelerated, and/or decelerated such thatthe insufflation amounts can be properly managed by the surgical hubsystem. When too much insufflation gas is being pushed into the patientby an insufflation system and/or a surgical instrument, and/or when theamount of insufflation gas being pushed into the patient through thesurgical instrument is increased too much, the surgical hub system canoperate to reduce the amount of insufflation gas being pushed into thepatient through the insufflation trocar. When the amount of insufflationgas being pushed into the patient through the surgical instrument isdecreased too much, the surgical hub system can operate to increase theamount of insufflation gas being pushed into the patient through theinsufflation trocar.

In addition to or in lieu of the above, the surgical instrumentcomprises a heating circuit positioned and configured to dry theelectrical interface when water intrusion in one of the electricalcircuits is detected by the control circuit. In at least one suchinstance, the heating circuit comprises a resistive heating circuit, forexample, comprising a heating resistor adjacent the electricalinterface. When the signal distortion and/or voltage drop exceeds apredetermined threshold, the control circuit can power the heatingcircuit and/or increase the current through the heating circuit, forexample. When the signal distortion and/or voltage drop falls below thepredetermined threshold, the control circuit can turn off the heatingcircuit immediately, power the heating circuit for a pre-set additionalperiod of time, and/or reduce the current in the heating circuit, forexample.

As discussed above, a shaft assembly can be selectively attachable to ahandle of a surgical instrument. As also discussed above, the shaftassembly can comprise a shaft flex circuit and the handle can comprise ahandle flex circuit. In various instances, the shaft flex circuit andthe handle flex circuit comprise electrical connectors whichinterconnect, or become electrically coupled, when the shaft assembly ismounted to the handle such that the flex circuits are placed inelectrical communication with one another. One or both of the electricalconnectors can comprise a seal which can seal the electricalinterconnection once the electrical connectors are mated; however, oneor both of the electrical connectors can comprise unsealed or exposedelectrical contacts prior to the interconnection being made. In certaininstances, the electrical contacts can be exposed to fluids and/orcontaminants. An alternative approach is illustrated in FIG. 615 whichdepicts a handle flex circuit 219220 and a shaft flex circuit 219520.The handle flex circuit 219220 comprises a flexible substrate andelectrical traces 219230 embedded in the flexible substrate. Similarly,the shaft flex circuit 219520 comprises a flexible substrate andelectrical traces 219530 embedded in the flexible substrate. Referringto FIG. 616 , the electrical traces 219230 and 219530 are positionedadjacent one another when the shaft assembly is mounted to the handleand are placed in communication with one another. In such instances, thetraces 219230 and 219530 form a capacitive and/or inductive connectioninterface and can communicate electrical signals and/or electrical poweracross the interface therebetween. As a result, the overlapping traces219230 and 219250 are enclosed and/or sealed such that their exposure tofluids and/or contaminants is reduced if not eliminated. The walls ofthe substrate surrounding the traces 219230 and 219530 can be thin and,in various instances, the traces 219230 and 219530 can be printed ontotheir respective substrates to improve the fidelity of theinterconnection therebetween.

As illustrated in FIGS. 615 and 616 , the traces 219230 and 219530comprise tips which overlap with one another when the flex circuits219220 and 219520 are interconnected. To facilitate thisinterconnection, the handle flex circuit 219220 comprises magnets 219240and the shaft flex circuit 219520 comprises magnets 219540 whicharranged in a manner so as to attract one another when brought intoclose approximation with one another and bring the flex circuits 219220and 219520 into contact with one another as illustrated in FIG. 616 .The magnets 219240 and 219540 are arranged in two pairs, but cancomprise any suitable number and/or arrangement.

A control circuit of a surgical instrument can be utilized to realizevariable rate control for a motor-driven system of the surgicalinstrument. Such motor-driven systems can include, for example, aclosing system, a firing system and/or an articulation system of asurgical instrument. In some instances, it is beneficial to utilize ahardware-only implementation of the control circuit to realize thevariable rate control of the motor-driven system. For example, ahardware-only implementation can be utilized to provide faster operationthan implementations which require software and/or firmware to beexecuted by a processing device. Also, a hardware-only implementationcan be utilized to eliminate the cost and complexity required withprocessors, software and/or firmware. Additionally, a hardware-onlyimplementation can offer increased reliability, increased durability andan increased life span of the control circuit. Furthermore, ahardware-only implementation can also expand options available forsterilization of the surgical instrument.

In various instances, the rotation of a knob of a surgical instrumentand/or the pulling or pressing of an input device of the surgicalinstrument can cause a proportional position change of the motor. Incertain instances, a variable pull of a switch or other input device ofthe surgical instrument can cause a proportional speed of motor advance.

FIG. 617 illustrates a control circuit 220000 of a surgical instrument.The control circuit 220000 is shown as a combinational logic circuit andis utilized to provide input signals and/or waveforms to a motorcontroller 220002 which controls the speed of rotation of a motor of thesurgical instrument. Responsive to the input signals from the controlcircuit 220000, the motor controller 200002 operates to alter rates ofaction of a device function based on a parameter that is sensed ortripped as a result of the function that is being performed. Forexample, in various instances, the device function may be thearticulation of an end effector of the surgical instrument, the rate ofaction may be the speed or velocity of the articulation away from alongitudinal axis of the shaft, and the parameter may be the position ofthe end effector relative to the longitudinal axis of the shaft. Invarious instances, the parameter that can be sensed or tripped is thestate of an input device, such as a switching device (either open orclosed), which can be changed or “bumped” by a user of the surgicalinstrument.

Further to the above, the control circuit 220000 includes a first ANDgate 220004, a monostable multivibrator 220006, an asynchronous counter220008, a first inverter 220010 (shown as a circle), a second AND gate220012, an OR gate 220014, a second inverter 220016 (shown as a circle)and a third AND gate 220018. In various instances, the control circuit220000 also includes the motor controller 22002.

A sensing device 220020, which is shown in FIG. 617 as a user switch, isconnected to a first input terminal 220022 of the first AND gate 220004and to an input terminal 220024 of the monostable multivibrator 220006.In various instances, the control circuit 220000 also includes thesensing device 220020, which may be implemented as a switching device,such as a limit switch, a position sensor, a pressure sensor, and/or aforce sensor, among others. According to various aspects, the sensingdevice 220020 may be implemented as an input device, such as a switchingdevice, which can be actuated or “bumped” by a user of the surgicalinstrument.

The sensing device 220020 is configured to sense a parameter associatedwith the surgical instrument and output a signal representative of thesensed parameter. For example, according to various aspects, the sensedparameter can be a user of the surgical instrument “pressing” or“bumping” the sensing device 220020. According to other aspects, thesensed parameter can be the end effector passing through a zone definedaround a centered state (e.g., through a zone defined relative to thelongitudinal axis of the shaft). The signal output by the sensing device220020 may be conditioned as needed (not shown) for input to the controlcircuit 220000. According to various aspects, the sensing device 220020may output a signal which is representative of a logic “1” or a “high”signal (e.g., 0.5 volts) when the end effector is not in the zonedefined around the centered state, and may output a signal which isrepresentative of a logic “0” or a “low” signal (e.g., 0.0 volts) whenthe end effector is in the zone defined around the centered state. It isto be understood that the above examples of 0.5 volts for a logic “1” ora “high” signal and 0.0 volts for a logic “0” or a “low” signal aremerely exemplary. Depending on the specific make and model of the logiccomponents utilized in the control circuit 220000, a voltage other than0.5 volts may be representative of a logic “1” or a “high” signal and avoltage other than 0.0 volts may be representative of a logic “0” or a“low” signal. As described in more detail hereinbelow, according tovarious aspects, a plurality of sensing devices 220020 (i.e., twosensing devices, three sensing devices, etc.) may output signals whichare for input to the control circuit 220000.

The monostable multivibrator 220006, also known as a “one-shot”,includes a resistor 220026 and a capacitor 220028 as depicted in FIG.617 , a first output terminal 220030, and a second output terminal220032. The signal Q which is output from the second output terminal220032 is a compliment of the signal Q which is output from the firstoutput terminal 220030. The resistor 220026 and the capacitor 220028collectively form a RC circuit. The monostable multivibrator 220006 isstructured to have only one stable state (e.g., a logic “0” outputstate). When a suitable trigger signal or pulse from the sensing device220020 is applied to the input terminal 220024 of the monostablevibrator 220006 (e.g., when a user of the surgical instrument presses orbumps the sensing device 220020), the monostable vibrator 220006generates an output signal Q (e.g., a single output pulse of a specifiedwidth) at the first output terminal 220030 for a period of time, and inthe process is forced from its stable state (e.g., a logic “0” outputstate) to another state (e.g., a logic “1” output state). The outputsignal Q is either a “high” signal or a “low” signal, and the period oftime is determined by a time constant of the RC circuit. If noadditional “bump” has been applied by the user to the sensing device220020 and/or no trigger signal or pulse from the sensing device 220020has been applied to the input terminal 220024 of the monostablemultivibrator 220006 during the period of time, the monostablemultivibrator 220006 will return to its stable state after the period oftime has elapsed (e.g., the output signal Q will go from a logic “1”output state to a logic “0” output state). The first output terminal Q220030 is connected to a first input terminal 220034 of the second ANDgate 220012. The second output terminal 220032 is connected to a resetinput terminal 220036 of the asynchronous counter 220008.

As described in more detail hereinbelow, according to various aspects,the monostable multivibrator 220006 can be a retriggerable monostablemultivibrator. If the user applies another “bump” to the sensing device220020 and/or another valid trigger signal or pulse from the sensingdevice 220020 is applied to the input terminal 220024 of the monostablevibrator 220006 before the output signal Q has returned to the stablestate (e.g., a logic “0” state), the width of the pulse of the outputsignal Q will be increased. Stated differently, the output signal Q willremain in its unstable state (e.g., a logic “1” state) for a longerperiod of time. Any number of user-initiated “bumps” of the sensingdevice 220020 and/or any number of valid trigger signals or pulses froma plurality of sensing devices 220020 can be applied to the inputterminal 220024 of the monostable vibrator 220006 before the outputsignal Q has returned to the stable state, with each applicationoperating to further increase the width of the pulse of the outputsignal Q.

The asynchronous counter 220008 includes a plurality of flip-flops (notshown), where the first one of the flip-flops is clocked by an externalclock and each of the subsequent flip-flops are clocked by the output ofthe preceding flip-flop. Since the external clock signal accumulatespropagation delays as it ripples through the plurality of flip-flops,the asynchronous counter 220008 is also known as a ripple counter. Asshown in FIG. 617 , the asynchronous counter 220008 includes a firstinput terminal 220038 which is connected to an output terminal 220040 ofthe first AND gate 220004, a reset input terminal 220036 which isconnected to the second output terminal 220032 of the monostablemultivibrator 220006, a first output terminal 220042, a second outputterminal 220044, and a third output terminal 220046. The first outputterminal 220042 of the asynchronous counter 220008 is connected to asecond input terminal 220048 of the second AND gate 220012. The secondoutput terminal 220044 of the asynchronous counter 220006 is connectedto a first input terminal 220050 of the OR gate 220014. The third outputterminal 220046 of the asynchronous counter 220006 is connected to aninput terminal 220052 of the first inverter 220010 (shown as a circle)which has an output terminal 220054 which is connected to a second inputterminal 220056 of the first AND gate 220004. According to variousaspects, the first inverter 220010 is incorporated into the first ANDgate 220004. The third output terminal 220046 of the asynchronouscounter 220008 is also connected to a second input terminal 220058 ofthe OR gate 220014.

The output terminal 220060 of the second AND gate 220012 is connected toa first input terminal 220062 of the third AND gate 220018. The outputterminal 220064 of the OR gate 220014 is connected to an input terminal220066 of the second inverter 220016 (shown as a circle) which has anoutput terminal 220068 which is connected to a second input terminal220070 of the third AND gate 220018. According to various aspects, thesecond inverter 220016 is incorporated into the third AND gate 220018.The output terminal 220064 of the OR gate 220014 is also connected to a“fast” input terminal 220072 of the motor controller 220002. The outputterminal 220074 of the third AND gate 220018 is connected to a “slow”input terminal 220076 of the motor controller 220002. According tovarious aspects, when the “slow” input terminal 220074 of the motorcontroller 220002 receives a “high” signal, the motor controller 220002operates to run a motor (e.g., an articulation motor) of the surgicalinstrument at a low speed. Similarly, when the “fast” input terminal220072 of the motor controller 220002 receives a high signal, the motorcontroller 200002 operates to run a motor (e.g., an articulation motor)of the surgical instrument at a high speed.

Although the control circuit 220000 is shown as a specific configurationof a hardware-only control circuit in FIG. 617 , it will be appreciatedthat according to other aspects the functionality of the control circuit220000 (e.g., realizing proportional speed control for a motor-drivensystem of the surgical instrument) can be implemented with other logicelements and/or other arrangements of logic elements.

FIG. 618 illustrates timing diagrams 220100 associated with the controlcircuit 220000 of FIG. 617 , in accordance with at least one aspect ofthe present disclosure. The first timing diagram 220102 is shown at thefar left side of FIG. 618 , and is representative of an instance when auser of the surgical instrument “bumps” the sensing device 220020 asingle time, or when a single trigger signal or pulse from the sensingdevice 220020 is applied to the input terminal 220024 of the monostablevibrator 220006.

When the monostable multivibrator 220006 is in a stable state (e.g.,when the user has not yet “bumped” the sensing device 220020 or thesensing device 200020 is in an open condition) as shown on the left-mostside of FIG. 618 , the output signal Q at the first output terminal220030 of the monostable multivibrator 220006 is a low signal, theoutput signals Q₀, Q₁ and Q₂ at the first, second and third outputterminals 220042, 220044, 220046 of the asynchronous counter 220008 arelow signals, and the signals at the “slow” and “fast” input terminals220076, 220072 to the motor controller 220002 are low signals.

When the user “bumps” the sensing device 220020 a single time or thesensing device 220020 is triggered a single time and/or transitions, asignal associated with the sensing device 220020 changes, and thechanged signal (e.g., in the form of a pulse going from high to low andthen back to high as shown in FIG. 618 ) is input at the input terminal220024 to the monostable multivibrator 220006. Responsive to the leadingedge of the pulse of the input signal, the Q output signal at the firstoutput terminal 220030 of the monostable multivibrator 220006transitions from a low signal to a high signal in the form of a pulsehaving a duration of T. The asynchronous counter 220008 recognizes thisfirst change (e.g., a change in count from 0 to 1) and operates totransition the output signal Q₀ at the first output terminal 220042 ofthe asynchronous counter 220008 from a low signal to a high signal inthe form of a pulse having a duration of T. The Q₁ and Q₂ signals at thesecond and third output terminals 220044, 220046 of the asynchronouscounter 220008 are not affected by the first change in the signalassociated with the sensing device 220020 and remain as low signals.

By having high signals at the first and second input terminals 220034,220048 of the second AND gate 220012, a high signal is at the outputterminal 220060 of the second AND gate 220012, and this high signal isalso at the first input terminal 220062 of the third AND gate 220018. Byhaving low signals at the first and second input terminals 220050,220058 of the OR gate 220014, the signals at the output terminal 220064of the OR gate 220064 and at the “fast” terminal of the motor controller220002 are also low signals. The low signal from the output terminal220064 of the OR gate is converted from a low signal to a high signal bythe second inverter 220016, and this high signal is at second inputterminal 220070 of the third AND gate 220018. By having high signals atthe first and second input terminals 220062, 220070 of the third ANDgate 220018, the signal at the output terminal 220074 of the third ANDgate is a high signal, and this high signal (in the form of a pulsehaving a duration of T) is also at the “slow” input terminal 220076 ofthe motor controller 220002. Thus, when a user “bumps” the sensingdevice 220020 a single time or a single trigger signal or pulse from thesensing device 220020 is applied to the input terminal 220024 of themonostable vibrator 220006, the motor controller 220002 causes the motorof the surgical instrument to run at a “slow” speed for a time T.

The second timing diagram 220104 is shown to the immediate right of thefirst timing diagram 220102, and is representative of an instance when auser “bumps” the sensing device twice or two trigger signals or pulsesfrom the sensing device 220020 (or from sensing devices 220020) areapplied to the input terminal 220024 of the monostable vibrator 220006,where the second of the “bumps” or of the trigger signals or pulses isapplied to the input terminal 220024 of the monostable vibrator 220006before the output signal Q has returned to the stable state (e.g., alogic “0” state). The second timing diagram 22104 is the same as thefirst timing diagram 220102 up until the time that the second “bump” orthe second trigger signal or pulse occurs. As the second of the “bumps”or of the trigger signal or pulse occurs before the output signal Q hasreturned to the stable state (e.g., a logic “0” state), the width of thepulse of the output signal Q is increased (the output signal Q remains ahigh signal for a period of time), and the width of the pulse of thesignal input to the “slow” input terminal 220076 of the motor controller220002 is increased (the signal remains a high signal for a period oftime), which results in the motor running at the “slow” speed from thetime of the first “bump” or of the trigger signal or pulse until theoccurrence of the falling edge of the output signal Q.

Additionally, the asynchronous counter 220008 recognizes this secondchange (e.g., a change in count from 1 to 2) and operates to transitionthe output signal Q₀ at the first output terminal 220042 of theasynchronous counter 220008 from a high signal back to a low signal, andto transition the output signal Q₁ at the second output terminal 220044of the asynchronous counter 220008 from a low signal to a high signal inthe form of a pulse having a duration of T. The Q₂ signal at the thirdoutput terminal 220046 of the asynchronous counter 220008 is notaffected by the second change in the signal associated with the sensingdevice 220020 and remains a low signal. Thus, when two user-initiated“bumps” of the sensing device 220002 or two trigger signals or pulsesfrom the sensing device 220020 (or from a plurality of sensing devices220020) are applied to the input terminal 220024 of the monostablevibrator 220006, where the second of the two “bumps” or of the triggersignals or pulses is applied while the output signal Q is still high,the motor controller 220002 operates to cause the motor of the surgicalinstrument to run at a “slow” speed for a time greater than T. In thisinstance, the time greater than T is the sum of the time T shortened bythe leading edge of the second “bump” or of the second trigger signal orpulse plus the time T.

The third timing diagram 220106 is shown to the immediate right of thesecond timing diagram 220104, and is representative of an instance whenthree “bumps” are applied to the sensing device 220020 or three triggersignals or pulses from the sensing device 220020 (or from sensingdevices 220020) are applied to the input terminal 220024 of themonostable vibrator 220006, where the second and third of the “bumps” orof the trigger signals or pulses are applied to the input terminal220024 of the monostable vibrator 220006 before the output signal Q hasreturned to the stable state (e.g., a logic “0” state). The third timingdiagram 22106 is the same as the second timing diagram 220104 up untilthe time that the third “bump” or trigger signal or pulse occurs. As thethird “bump” or trigger signal or pulse occurs before the output signalQ has returned to the stable state (e.g., a logic “0” state), the widthof the pulse of the output signal Q is increased (the output signal Qremains a high signal for a period of time). This causes the motorcontroller 220002 to run the motor at a “slow” speed during the timeassociated with the first and second “bumps” or trigger signals orpulses until the occurrence of the rising edge of the output signal Q₀,the falling edge of the output signal Q₁ and the rising edge of theoutput signal Q₂. Thereafter, the motor controller 220002 operates torun the motor at a “fast” speed for the time T after the third “bump” ortrigger signal or pulse until the occurrence of the falling edge of theoutput signal Q, the falling edge of the signal Q₀ and the falling edgeof the output signal Q₂.

The asynchronous counter 220008 recognizes this third change (e.g., achange in count from 2 to 3) and operates to transition the outputsignal Q₁ at the second output terminal 220044 of the asynchronouscounter 220008 from a high signal back to a low signal, to transitionthe output signal Q₀ at the first output terminal 220042 of theasynchronous counter 220008 from a low signal to a high signal in theform of a pulse having a duration of T, and to transition the outputsignal Q₂ at the third output terminal 220046 of the asynchronouscounter 220008 from a low signal to a high signal in the form of apulse. As shown in FIG. 618 , due to some propagation delay, the outputsignal Q₂ transitions somewhat later than the output signal Q₀ does, andthus has a duration somewhat less than T. The transitions of the Q₀output signal, the Q₁ output signal and the Q₂ output signal operate tocause the signal at the slow input terminal 220076 of the motorcontroller 220002 to transition from a high signal back to a low signal,and to cause the signal at the “fast” input terminal 220072 of the motorcontroller 220002 to transition from a low signal to a high signal(e.g., in the form of a pulse having a duration of T). Thus, when three“bumps” or trigger signals or pulses from the sensing device 220020 (orfrom a plurality of sensing devices 220020) are applied to the inputterminal 220024 of the monostable vibrator 220006, where the second andthird of the three “bumps” or trigger signals or pulses are appliedwhile the Q output signal is still high, the motor controller 220002operates to cause the motor of the surgical instrument to run at a“slow” speed for a time greater than T (i.e., the sum of the time Tshortened by the leading edge of the second trigger signal or pulse plusthe time T), then to run at a “fast” speed for the time T.

The fourth timing diagram 220108 is shown to the immediate right of thethird timing diagram 220106, and is representative of an instance whenmultiple (e.g., more than three) “bumps” are applied to the sensingdevice 220020 or multiple trigger signals or pulses from the sensingdevice 220020 (or from sensing devices 200020) are applied to the inputterminal 220024 of the monostable vibrator 220006, where each of the“bumps” or trigger signals or pulses occur after the first “bump” isapplied to the sensing device 220020 or after the first trigger signalor pulse is applied to the input terminal 220024 of the monostablevibrator 220006 before the output signal Q has returned to the stablestate (e.g., a logic “0” state). The fourth timing diagram 22108 is thesame as the third timing diagram 220106 up until the time that thefourth “bump” or trigger signal or pulse occurs. As the fourth “bump” ortrigger signal or pulse occurs before the output signal Q has returnedto the stable state (e.g., a logic “0” state), the width of the pulse ofthe output signal Q is increased (the output signal Q remains a highsignal for a period of time). This causes the motor controller 220002 tocause the motor to continue to run at a “fast” speed as long as the Qoutput signal is high (e.g. for the time T after the fourth “bump”,trigger signal or pulse). The asynchronous counter 220008 is reset onthe falling edge of the output signal Q2.

The asynchronous counter 220008 recognizes this fourth change (e.g., achange in count from 3 to 4) and operates to extend the width of thepulse of the output signal Q₁ at the second output terminal 220044 ofthe asynchronous counter 220008, and to shorten the duration of thesecond pulse of the output signal Q₀ at the first output terminal 220042of the asynchronous counter 220006.

As shown in the timing diagram 220108, as additional “bumps” (e.g., afifth “bump”, a sixth “bump”, etc.) are applied to the sensing device220020 or additional trigger signals or pulses (e.g., a fifth triggersignal or pulse, a sixth trigger signal or pulse, etc.) from the sensingdevice 220020 (or from sensing devices 200020) are applied to the inputterminal 220024 of the monostable vibrator 220006 before the outputsignal Q has returned to the stable state (e.g., a logic “0” state), thewidth of the pulse of the output signal Q₂ is extended until a time Thas elapsed after the last “bump”, trigger signal or pulse has beenapplied before the output signal Q has returned to the stable state(e.g., a logic “0” state). Thus, when four or more “bumps” or triggersignals or pulses have occurred, where the second, third, fourth, etc.of the four or more “bumps” or trigger signals or pulses are appliedwhile the Q output signal is still high, the motor controller 220002operates to cause the motor of the surgical instrument to run at a“slow” speed for a time greater than T (i.e., the sum of the time Tshortened by the leading edge of the second trigger signal or pulse plusthe time T), then to run at a “fast” speed until a time T has elapsedafter the last “bump”, trigger signal or pulse is applied before theoutput signal Q has returned to the stable state. The Q₂ output signalremains high until the asynchronous counter 220008 is reset on thefalling edge of the output signal Q.

In some applications, the control circuit 220000 does not have to be assophisticated as is shown in FIG. 617 . For example, in someapplications, it may be desirable to run the motor at a “slow” speedinitially for a short period of time then allow the motor to speed up toa faster speed or to a full speed. This can be useful, for example, whenarticulating an end effector of a surgical instrument. For example,according to various aspects, a control circuit for the articulationsystem of the surgical instrument can be implemented with an“end-of-stoke” switch that allows the articulation motor to be operatedin the reverse direction but not any further in the forward directionwhile the “end-of-stroke” switch is tripped. In other applications, itmay be desirable to change the speed of the motor from a slow speed to afast speed, or from a fast speed to a slow speed, for a controllableperiod of time.

FIG. 619 illustrates a control circuit 220200 of a surgical instrument.The control circuit 220200 is shown as a combinational logic circuit andmay be utilized to provide input signals and/or waveforms to a motorcontroller (not shown for purposes of simplicity in FIG. 619 ).Responsive to the input signals from the control circuit 220200, themotor controller operates to change the motor speed when an input deviceof the surgical instrument is held in a given position for a period oftime.

The control circuit 220200 is similar to the control circuit 220000 ofFIG. 617 in that the control circuit 220200 includes a monostablemultivibrator 220202, a first inverter 220204, and a second inverter220206, but is different in that it does not include the othercomponents of control circuit 220000 and has a different functionality.According to various aspects, the control circuit 220200 includes themotor controller, which may be similar or identical to the motorcontroller 220002 of FIG. 617 .

A sensing device 220208, which is shown in FIG. 619 as a switchingdevice, is connected to an input terminal 220210 of the first inverter220204, to an input terminal 220212 of the second inverter 220206, andto a first input terminal 220214 of the monostable multivibrator 220202.According to various aspects, the control circuit 220200 also includesthe sensing device 220208, which may be implemented as a trigger, aswitching device, such as a push button, a limit switch, a positionsensor, a pressure sensor, and/or a force sensor, among others.

The monostable multivibrator 220202 can be similar or identical to themonostable vibrator 220006, and includes a resistor 220216 and acapacitor 220218 as depicted in FIG. 619 , the first input terminal220214, a reset input terminal 220220, and a first output terminal220222. The resistor 220216 and the capacitor 220218 collectively form aRC circuit. The first output terminal 220222 of the monostablemultivibrator 220202 is connected to a “motor fast” input terminal ofthe motor controller.

The first inverter 220204 also includes an output terminal 220224 whichis connected to a “motor slow” input terminal of the motor controller.The second inverter 220206 also includes an output terminal 220226 whichis connected to the reset input terminal 220220 of the monostablemultivibrator 220202.

In operation, when the sensing device 220208 is changed from an openposition as shown in FIG. 619 to a closed position and held in place fora period of time(e.g., by a user of the surgical instrument), a “low”signal is applied to the input terminal 220210 of the first inverter220204, to the input terminal 220212 of the second inverter 220206, andto the first input terminal 220214 of the monostable multivibrator220202. The first inverter 220204 operates to invert the “low” signal toa “high” signal at the output terminal 220224 of the first inverter220204, which results in a “high” signal being at the “motor slow” inputterminal of the motor controller, resulting in a motor (e.g., anarticulation motor) of the surgical instrument being operated at a“slow” speed. The second inverter 220206 also operates to invert the“low” signal to a “high” signal at the output terminal 220226 of thesecond inverter 220206, which results in a “high” signal being at thereset input terminal 220220 of the monostable multivibrator 220202. Oncethe sensing device 220208 is released from its “held” position, after aperiod of time determined by a time constant of the RC circuit, themonostable multivibrator 220202 operates to generate a “high” signal(the output signal Q) at the output terminal 220222 of the monostablemultivibrator 220202, which results in a “high” signal being at the“motor fast” input terminal of the motor controller. The time constantcan be on the order of approximately 0.5 seconds to 1.0 seconds, forexample. The “high” signal at the “motor fast” input terminal of themotor controller results in the motor of the surgical instrumentchanging from a “slow” speed of rotation to a “fast” of “full” speed ofrotation. The timer of the monostable multivibrator 220202 is reset oncethe sensing device 220208 changes from a closed state back to an openstate (e.g., by releasing the push button). Thus, in cooperation withthe sensing device 220208, the control circuit 220200 can be utilized tocreate a “slow” motor speed for a controllable period of time, followedby the speed of the motor then being increased to a “fast” motor speedor all the way up to a “full” motor speed.

Although the control circuit 220200 is described above in the context ofa controllable “slow” speed followed by a “fast” speed, it will beappreciated that the control circuit 220200 can also be configured torealize a controllable “fast” speed followed by a “slower” speed. Itwill be appreciated that the control circuit 220200 can be implementedwith solid state circuits configured to create different motor speeds.According to various aspects, the surgical instrument can include aswitching system configured to slow the articulation motor as it passesthru a predefined portion of the articulation arc. According to variousaspects, the surgical instrument can also include a switching systemconfigured to rotate an anvil to an open position at a relatively fastspeed. For example, a switch could be located on the anvil at pointwhere positive opening tabs contact, and the closing of the switch canoperate to cause a fast period of opening when the switch is tripped.According to various aspects, the control circuit can be configured toprevent a single point failure in motor control circuit.

As discussed above, a control circuit is configured to control the powerdelivered to an electric motor. In some instances, a light emittingdiode (LED) array can be configured as a proportional display to showmotor speed or current. For example, a display driver such as the LM3914by Texas Instruments can be utilized to drive a display that isproportional to current. Different colors, different placement ordifferent LEDs (or even skipping some LEDs on the display array) can beutilized to emphasize that the current is proportional to the load onthe motor system.

FIG. 620 illustrates a control circuit 220400 configured to indicate thepower being delivered to the electric motor. The control circuit 220400comprises a power supply 220410, a motor control circuit 220420, aLM3914 integrated circuit (or similar display driver) 220430, and asegmented display 220450 in communication with a plurality of gates orcontacts 220440 defined on the integrated circuit 220430. The integratedcircuit 220430 comprises ten comparators and a resistor scaling network,for example; however, the integrated circuit 220430 can comprise anysuitable arrangement to drive a graduated display (See FIG. 621 ) whichindicates the current being drawn by the electric motor. The segmenteddisplay 220450 comprises ten light emitting diodes (LEDs), i.e.,220451-220460, which are each in communication with one of the contacts220440. For the control circuit 220400, the LEDs 220451-220460 light upin proportion to the motor current being drawn, which is in proportionto the torque applied/delivered by the motor, either in the forwarddirection or the reverse direction.

Each LED represents 10 percent of the maximum applicable current to theelectric motor. Thus, the LED 220541 is illuminated when the electricmotor is drawing more than 10 percent of the total current available(and when the motor is applying/delivering a low torque). If the motorcurrent draw does not exceed 20 percent, however, the second LED 220452is not illuminated—nor are the LEDs 220453-220460. When the electricmotor is drawing more than 20 percent of the total current available,the second LED 220452 is illuminated, and so forth. When the electricmotor is drawing 100% of the available current, all of the LEDs220451-220460 are illuminated (and when the motor is applying/deliveringa high torque).

In at least one alternative aspect, some of the LEDs, such as the ninthand tenth LEDs 220459 and 220460 represent an overdrive condition of theelectric motor. Moreover, while ten LEDs provide a convenientlyunderstandable display, any suitable number of LEDs could be used, suchas three LEDs, for example. In such instances, a first LED, whenilluminated, would represent a low torque condition, a second LED, whenilluminated, would represent a mid-torque condition, and a third LED,when illuminated, would represent a high-torque condition, for example.Although FIGS. 620 and 621 are described in the context of current beingdrawn by the motor, it will be appreciated that similar circuitry couldbe utilized to provide an indication of motor speed by measuring anddisplaying motor voltage instead of motor current.

FIG. 622 illustrates a surgical instrument comprising a handle 220100.The handle 220100 comprises a handle housing 220110, actuators, and acontrol system configured to operate the surgical instrument. Similar toother surgical instruments disclosed herein, the control system of thehandle 220100 is configured to communicate with a surgical hub system.While the handle 220100 can be configured to communicate wirelessly withthe surgical hub system via electromagnetic waves, the handle 220100comprises an acoustic speaker and/or an acoustic sensor configured tocommunicate with the surgical hub system. The surgical hub system alsocomprises an acoustic speaker and/or an acoustic sensor in the sameroom, or at least within sufficient auditory range, as the surgicalinstrument so as to communicate with the surgical instrument. Such datacommunication is wireless, and can comprise various chirps, for example,which may or may not be within the auditory range of a human being. Thesignals can be above, within, and/or below the auditory range of a humanbeing. An acoustic system advantageously does not rely on emittingelectromagnetic waves which may interfere with the operation of asurgical instrument and/or system, for example, in the same operatingroom.

In some instances, it is desirable to configure a circuit to determinethe suitability of the circuit before the circuit is energized. Forexample, it would be desirable to detect the return path capacity of anelectrosurgical circuit, and if the return path capacity is notsufficient, limit the amount of electrosurgical energy to be applied toa patient without exceeding a predefined localized current threshold.According to various aspects, the surface area and the resistance levelsof the grounding pad are used to determine the return path capacity, andif the return path capacity is found to be insufficient, the output ofthe monopolar generator is limited to a level below the localizedcurrent level threshold. In practice, it is beneficial to maximize thegenerator coupling to patient for the highest efficiency and to realizethe best electrosurgical performance while limiting the power when thepatient contact quality is changed or goes below a threshold where aburn is possible. According to various aspects, a printed flex circuitof the electrosurgical system includes a predefined zone with an alteredarea which acts as a fuse to define the maximum capacity of the returnpath.

FIG. 623 illustrates a surgical system 220300, in accordance with atleast one aspect of the present disclosure. The surgical system 220300includes a surgical hub 220302, an electro-surgical instrument 220304, acapacitive return pad 220306, and a cable or cord 220308 which connectsthe capacitive return pad 220306 with the surgical hub 220302. Thecapacitive return pad 220306 and the cable or cord 220308 collectivelyform a return path for the electrosurgical energy applied to the patientvia the electrosurgical instrument 220304. When applying electrosurgicalenergy to a patient, it is important to ensure that the current-carryingcapacity of the return path is sufficient to handle the amount ofelectrosurgical energy applied to the patient.

The surgical hub 220302 includes a monopolar generator module 220310,and the monopolar generator module 220310 includes a sensing device (seeFIG. 624 ) configured to sense electrical continuity in the return pathfor the electrosurgical energy. Various aspects of a surgical hub aredescribed in more detail in U.S. patent application Ser. No. 15/940,629,entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS, filed onMar. 29, 2018, the disclosure of which is hereby incorporated byreference in its entirety. Various aspects of a electro-surgicalinstrument and a capacitive return pad are described in more detail inU.S. patent application Ser. No. 16/024,090, entitled CAPACITIVE COUPLEDRETURN PAD WITH SEPARABLE ARRAY ELEMENTS, filed on Jun. 29, 2018, thedisclosure of which is hereby incorporated by reference in its entirety.

As described in more detail hereinbelow, the surgical system 220300 isconfigured to detect the current-carrying capacity of the return path(by sensing the continuity of the return path) and limit the maximumamount of electrosurgical energy applied to the patient (by controllingthe electrosurgical energy delivered by the monopolar generator module220310), without exceeding a predefined localized current threshold.

FIG. 624 illustrates a schematic diagram 220400 which is representativeof current and signal paths of the surgical system 220300 of FIG. 623 ,in accordance with at least one aspect of the present disclosure.Electrosurgical current is supplied by the monopolar generator module220310 of the surgical hub 220302 to the electro-surgical instrument220304, where is it selectively applied to a patient 220312. The appliedelectrosurgical current passes through the body of the patient 220312and is received by the capacitive return pad 220306, then subsequentlypasses through the cable or cord 220308 back to the monopolar generatormodule 220310 of the surgical hub 220302 to complete the path followedby the electrosurgical current.

Although the sensing device 220314 of the monopolar generator module220310 of the surgical hub 220302 is shown schematically in FIG. 624 assensing the electrical continuity between the capacitive return pad220306 and the electrosurgical instrument 220304, it will be appreciatedthat the sensing device 220314 senses the electrical continuity from thecapacitive return pad 220306 and the cable or cord 220308 to theelectrosurgical instrument 220304 via the sensing device 220314positioned within the monopolar generator module 220310. The sensingdevice 220314 operates to monitor the continuity, and is configured togenerate an output signal which is representative of the integrityand/or current carrying-capacity of the return path. The output signalgenerated by the sensing device 220314 is passed to a control system220316 of the monopolar generator module 220310, and the control system220316 operates to control the amount of electrosurgical energydelivered to the electrosurgical instrument 220304. In instances wherethe continuity of the return path is less than absolute (e.g., where theintegrity of the return path varies from absolute), the control system220316 operates to limit the amount of electrosurgical energy deliveredto the electrosurgical instrument 220304, without exceeding a predefinedlocalized current threshold.

FIG. 625 illustrates a graph 220500 which shows a relationship between acontinuity level of the patient 220312 and the level of electrosurgicalpower supplied by the monopolar generator module 220310 of the surgicalsystem 220300 of FIG. 623 , in accordance with at least one aspect ofthe present disclosure. The continuity level of the patient 220312, asmeasured by the resistance of the patient 220312, can serve as a proxyfor the continuity level of the return path of the surgical system220300. The graph 220500 includes two horizontal axes—an “upper”horizontal axis 220502 and a “lower” horizontal axis 220504. The time tis shown along the “lower” horizontal axis 220504, but is not shownalong the “upper” x-axis 220502 for purposes of clarity. However, asindicated by the vertical dashed lines shown in FIG. 625 , the “upper”horizontal axis 220502 and the “lower” horizontal axis 220504 arealigned with one another. The graph 220500 also includes two verticalaxes—an “upper” vertical axis 220506 and a “lower” vertical axis 220508.The level of electrosurgical power supplied by the monopolar generatormodule 220310 of the surgical system 220300 is shown along the “upper”y-axis 220506 and the continuity level of the patient 220312, asmeasured by the resistance of the patient 220312, is shown along the“lower” y-axis 220508.

The graph 220500 further includes a maximum power threshold 220510 forthe monopolar generator module 220310, a potential power level 220514available at the electrosurgical instrument 220304 for application tothe patient 220312, a user setting 220516 for the power level suppliedby the monopolar generator module 220310, the actual power level 220518of electrosurgical energy applied by the electrosurgical instrument220304, and the electrical continuity 220520 of the patient 220312, asmeasured by the resistance of the patient 220312. As described in moredetail hereinbelow, as the continuity of the patient 220312 varies(which corresponds to variations of the detected return path integrity),the level of electrosurgical energy supplied by the monopolar generatormodule 220310 varies.

Starting at time t=0 at the left hand side of the “lower” horizontalaxis 220504, as well as at the left hand side of the “upper” horizontalaxis 220502, and moving toward time t₁, as the continuity of the patient220312 begins to increase, the level of power supplied by the monopolargenerator module 220310 begins to increase. From time t₁ to time t₂, asthe continuity of the patient 220312 levels off and remains relativelyconstant, the level of power supplied by the monopolar generator module220310 levels off and remains relatively constant. From time t₂ to timet₃, as the continuity of the patient 220312 further increases, the levelof power supplied by the monopolar generator module 220310 furtherincreases and reaches the user setting 220516 for the monopolargenerator module 220310. From time t₃ to time t₄, as the continuity ofthe patient 220312 levels off and remains relatively constant, the levelof power supplied by the monopolar generator module 220310 levels offand remains relatively constant. At time t₄, as the continuity level ofthe patient 220312 decreases, the level of power supplied by themonopolar generator module 220310 decreases. As shown in FIG. 625 ,according to various aspects, if a loss of integrity of the return pathis detected, the power supplied by the monopolar generator module 220310can be turned off (the level of power supplied by the monopolargenerator module 220310 decreases to zero) for a period of time to allowfor the integrity of the return path to be verified (e.g., by thecontrol system 220316 of the monopolar generator module 220310) beforeallowing for the power to start being supplied again by the monopolargenerator module 220310. In FIG. 625 , the period of time is representedby the wait time t_(w) which is shown as the period of time between timet₄ and time t₅.

From time t₄ to time t₅, while the power supplied by the monopolargenerator module 220310 is shown as zero, the continuity of the patient220312 levels off and remains relatively constant. At time t₅, once thewait time t_(w) has been reached, the power to the monopolar generatormodule 220310 is restored and the power supplied by the monopolargenerator module 220310 increases. From time t₅ to time t₆, as thecontinuity of the patient 220312 continues to remain relativelyconstant, the level of power supplied by the monopolar generator module220310 levels off and remains relatively constant. At time t₆, as thecontinuity level of the patient increases again, the level of powersupplied by the monopolar generator module 220310 increases again, inthis case up to but not exceeding the power level associated with theuser setting 220516. After time t₆, as the continuity of the patient220312 levels off and then continues to remain relatively constant, thelevel of power supplied by the monopolar generator module 220310 levelsoff at the power level associated with the user setting 220516 and thenremains relatively constant.

According to various aspects, to more easily accomplish certainfunctions (e.g., articulation), the surgical instrument includes one ormore flexible circuits. According to various aspects, the flexiblecircuits are configured such that (1) the impact of any vibration on theflexible circuit is minimized, (2) solid chip attachment locations aresealed off from fluids and/or (3) the flexible circuits are easilyinner-connectable to one another. According to various aspects, thesubstrates of one or more of the flexible circuits are bio-compatiblewith tissue of the patient, and such flexible circuits can be implantedwithin the patient. According to various aspects, the flexible circuitscan have tubular part features for housing leads from the flexiblecircuit while the flexible circuit is being assembled but notnecessarily at the final assembly locations. According to variousaspects, electrical and/or mechanical sensors can be integrated into theflexible circuits.

Shielding can be integrated with/built into the flexible circuits toprevent unwanted radio-frequency (RF) interference from affecting theperformance of the flexible circuits. In certain aspects, the flexiblecircuits can include various configurations of twisted pair wiring. Inaddition to providing for the transmission of power and/or signalswithin the surgical instrument, the twisted pair wiring can beconfigured to provide one or more secondary functions. Such secondaryfunctions can include, for example, shielding the twisted pair wiringfrom electromagnetic interference, short-circuit detection, and/orcontamination detection.

FIG. 626 illustrates a flexible circuit 220600 of a surgical instrument.The flexible circuit 220600 includes a twisted pair of conductors, wherethe twisted pair of conductors includes a “top” conductive trace 220602and a “bottom” conductive trace 220604. As shown in FIG. 626 , the “top”and “bottom” conductive traces 220602, 220604 overlap one another atregular intervals. When a current or a signal is being carried throughthe twisted pair of conductors, the overlapped configuration of the“top” and “bottom” conductive traces 220602, 220604 operates to betterprotect the current or signal from potential interference from anexternal electromagnetic field. This is particularly true when theprimary macro-direction of the flexible circuit 220600 is parallel tothe source of the electromagnetic field which can cause the potentialinterference.

The flexible circuit 220600 also includes a first layer 220606 of aninsulative material, a second layer 220608 of an insulative material anda third layer 220610 of an insulative material. The first layer 220606of the insulative material is positioned “below” the “bottom” conductivetrace 220604. The second layer 220608 is positioned “above” the “bottom”conductive trace 220604 and “below” the “top” conductive trace 220602(i.e., between the “top” and “bottom” conductive traces 220602, 220604).The third insulative layer 220610 is positioned “above” the “top”conductive trace 220602. According to various aspects, the “bottom”conductive trace 220604 is formed directly on the first layer 220606 ofthe insulative material, and the “top” conductive trace 220602 is formeddirectly on either the second layer 220608 of the insulative material orthe third layer 220610 of the insulative material. According to variousaspects, the first layer 220606, the second layer 220608 and the thirdlayer 220610 each comprise a polymer such as, for example, a polyimide.

FIG. 627 illustrates a cross-section of the flexible circuit 220600 ofFIG. 626 . The hatched areas shown on the “top” and “bottom” conductivetraces 220602, 220604 represent the areas where the “top” and “bottom”conductive traces 220602, 220604 overlap one another. As shown in FIG.627 , when a source 220612 generates an electromagnetic field 220614(shown as electromagnetic field lines), the overlapped configuration ofthe “top” and “bottom” conductive traces 220602, 220604 operate to blockor reject the electromagnetic field 220614 which can cause the potentialinterference, especially so along the direction of the dashed line220616. According to various aspects, flexible circuits other than thosewith twisted pairs of conductors can be configured to provide theabove-mentioned secondary functions.

FIG. 628 illustrates a flexible circuit 220700 of a surgical instrument.The flexible circuit 220700 includes a first plurality of conductivetraces 220702 and a second plurality of conductive traces 220704, wherethe first and second pluralities of conductive traces 220702, 220704 arepositioned at different layers of the flexible circuit 220700. Theflexible circuit 220700 also includes a first layer 220706 of aninsulative material, a second layer 220708 of an insulative material, athird layer 220710 of an insulative material, a fourth layer 22712 of aninsulative material, and a fifth layer 22714 of an insulative material.The first layer 220706 of the insulative material is positioned “below”the second plurality of conductive traces 220704. The second layer220708 is positioned “above” the second plurality of conductive traces220704 and “below” the first plurality of conductive traces 220702(i.e., between the first and second pluralities of conductive traces220702, 220704). The third insulative layer 220610 is positioned “above”the first plurality of conductive traces 220702. According to variousaspects, the second plurality of conductive traces 220704 is formeddirectly on the first layer 220706 of the insulative material, and thefirst plurality of conductive traces 220702 is formed directly on eitherthe second layer 220708 of the insulative material or the third layer220710 of the insulative material. According to various aspects, thefirst layer 220706, the second layer 220708, the third layer 220710, thefourth layer 220712 and the fifth layer 220714 each comprise a polymersuch as, for example, a polyimide.

Referring to FIG. 629 , the flexible circuit 220700 further includes afirst shield layer 220716, a second shield layer 220718, and verticalshields 220720. The vertical shields 220720 are formed through vias inthe first, second and third layers 220706, 220708, 220710 of theinsulative material. The first shield layer 220716, the second shieldlayer 220718, and the vertical shields 220720 collectively operate tobetter protect currents or signals being carried through the firstand/or second pluralities of conductive traces 220702, 220704 frompotential interference from an external electromagnetic field. The firstshield layer 220716 is positioned “above” the third layer 220710 ofinsulative material and “below” the fifth layer 220714 of insulativematerial (i.e., between the third and fifth layers 220710, 220714 ofinsulative material). The second shield layer 220718 is positioned“above” the fourth layer 220712 of insulative material and “below” thefirst layer 220706 of insulative material (i.e., between the fifth andfirst layers 220712, 220706 of insulative material). The verticalshields 220720 are connected to the first and second shield layers220712, 220714, and surround the “left” and “right” sides of the firstand second pluralities of conductive traces 220702, 220704. As the firstshield layer 220712 covers the “bottom” of the second plurality ofconductive traces 220704 and the second shield layer 220714 covers the“top” of the first plurality of conductive traces 220702, the firstshield layer 220712, the second shield layer 220714 and the verticalshields 220720 collectively cooperate to form an electromagnetic shieldwhich surrounds a cross-section of the first and second pluralities ofconductive traces 220702, 220704.

Further to the above, the flexible circuit 220700 can additionallyinclude shield traces 220722 (see FIG. 629 ) which can be positionedalongside and along the length of the “left” and “right” sides of thefirst and second pluralities of conductive traces 220702, 220704 suchthat the first shield layer 220712, the second shield layer 220714, thevertical shields 220720 and the trace shields 220722 collectivelycooperate to form an electromagnetic shield which surrounds a length ofthe first and second pluralities of conductive traces 220702, 220704.The position and arrangement of the first, second, third, fourth and/orfifth layers 220706, 220708, 220710, 220712, 220714 of insulativematerial provide the secondary function of providing short-circuitprotection between the first and second pluralities of conductive traces220702, 220704 and/or between the electromagnetic shield and the firstand second pluralities of conductive traces 220702, 220704. Byeffectively surrounding a length of the first and second pluralities ofconductive traces 220702, 220704, the first shield layer 220712, thesecond shield layer 220714, the vertical shields 220720 and the traceshields 220722 collectively operate to protect the flexible circuit220700 from potential interference from an external electromagneticfield.

Further to the above, a flex circuit of a surgical instrument cancomprise components configured to absorb, distribute, and/or otherwiseaddress electromagnetic interference (EMI) from components within thesurgical instrument and/or an adjacent surgical instrument, for example.Referring to FIG. 630 , a circuitous flex circuit 219520 extendsalongside a shaft shroud 219510 and, in certain instances, passesclosely to an EMI emitting component, such as 219590, for example. Theflex circuit further comprises components 219550, such as ferrites,inductors, capacitors, and/or snubber networks, for example, where theyare needed. Smaller components can be used if the burden of absorbingthe EMI is shared across multiple components. In certain instances, thecomponents 219550 bridge or extend between two or more conductive traces219530 in the flex circuit 219520.

The aspects which provide for provide short-circuit detection and/orcontamination detection are described with reference to FIGS. 615 and616 hereinabove.

A control circuit of a surgical instrument can be utilized to controlone or more motor-driven systems of the surgical instrument. Suchmotor-driven systems can include an end effector closing system, an endeffector articulation system, and/or a firing system, for example. Insome instances, it is beneficial to utilize a parameter of amotor-driven system to control the motor-driven system. For example, asexplained in greater detail below, a parameter such as acoustic data,vibration data, and/or acceleration data associated with themotor-driven system can provide an indication that one or morecomponents of the motor-driven system is experiencing degradation,operating in a damaged state, and/or heading toward failure, forexample, and can be utilized to control the motor-driven system in lightof these potential issues.

FIG. 631 illustrates a control circuit 221000 of a surgical instrument.The control circuit 221000 is configured as a closed-loop system whichutilizes an acoustic measurement to control the rotation speed of anelectric motor, such as a drive motor, for example, of the surgicalinstrument. As the rotation speed of an electric motor has a distinctrelationship to the torque applied/delivered by the electric motor (thespeed and the torque can be inversely proportional to one another), thecontrol circuit 221000 can also be considered as being configured as aclosed-loop system which utilizes an acoustic measurement to control thetorque applied/delivered by an electric motor, such as a drive motor,for example, of the surgical instrument. For purposes of simplicity, thecontrol circuit 221000 will be described hereinafter in the context ofcontrolling the rotation speed of the electric motor of the surgicalinstrument.

The control circuit 221000 includes at least one acoustic sensor 221002,at least one signal conditioner 221004, at least one Fast FourierTransform (FFT) circuit 221006, at least one frequency-to-voltageconverter 221008, and at least one summing amplifier 221010. The controlcircuit 221000 further comprises a motor drive circuit 221020 which isconfigured to control the electric motor, as described in greater detailbelow. In various instances, the control circuit 221000 forms a part ofanother control circuit of the surgical instrument. For example, thecontrol circuit 221000 can form a part of the control circuit whichincludes a main processing circuit and/or main processor of the surgicalinstrument, and/or one or more memory devices, for example.

The acoustic sensor 221002 is configured to sense acoustic information,in the form of vibration energy, associated with an electric motor221012, gearboxes 221014, 221016 operably coupled to the motor 221012,and/or a drive train 221018 operably coupled with the gearboxes 221014,221016. The electric motor 221012, the gearboxes 221014, 221016 and thedrive train 221018 collectively form a drive system of the surgicalinstrument. Thus, the acoustic sensor can be considered as beingconfigured to measure a parameter of the drive system of the surgicalinstrument. In various instances, the acoustic sensor 221002 comprises apiezoelectric pickup, for example, responsive to the acoustic forcestransmitted by the soundwaves emitted from the motor 221012, thegearboxes 221014, 221016, and/or the drive train 221018. The acousticsensor 221002 is configured to convert the mechanical energy from thesound waves into electrical energy in the form of electric signals orvoltage potentials within the circuitry of the acoustic sensor 221002.Notably, the acoustic information sensed by the acoustic sensor 221002is not limited to vibrations within the range of human hearing.Vibrations above or below the range of human hearing can also be sensedby the acoustic sensor 221002 and converted into electrical energy.

Further to the above, the gearboxes 221014, 221016 comprise speedreduction gearboxes configured to produce a rotational output which isslower than the output speed of the electric motor 221012. As a result,the electric motor 221012 and the drive train 221018 rotate at differentspeeds and, accordingly, have different acoustic signatures. The inputof the first gearbox 221014 rotates at the speed of the electric motor221012 while the output of the first gearbox 221014 rotates at a slowerspeed than the electric motor 221012 and, as such, the first gearbox221014 has a different acoustic signature than the electric motor221012. Similarly, the input of the second gearbox 221016 rotates at thespeed of the first gearbox 221014 output and the output of the secondgearbox 221016 rotates at a different speed than its input. As such, thesecond gearbox 22106 has a different acoustic signature than the firstgearbox 221014. Each of these acoustic signatures has a frequencycontent, including wavelength and amplitude/magnitude, which is relatedto the speed of the respective component.

The signal conditioner 221004 is configured to receive the acousticinformation (e.g., electric signals or voltage potentials) from theacoustic sensor 221002 and convert the acoustic information into anothertype of electrical signals. For example, in various instances, thesignal conditioner 221004 may amplify the magnitude of the electricalsignals from the acoustic sensor 221002, filter out noise within theelectrical signals from the acoustic filter 221002, etc. The fastFourier transform (FFT) circuit 221006 executes a FFT algorithm whichanalyzes the electrical signals from the signal conditioner 221004 andconverts the electrical signals from a time domain to a representationin the frequency domain. In various instances, a main processing circuitof the surgical instrument can execute the FFT algorithm. The convertedelectrical signals may be considered frequency component signals. Thefrequency-to-voltage converter 221008 is configured to convert thefrequency component signals provided by the FFT circuit 221006 to aproportional voltage signal. The proportional voltage signal is used asa feedback signal which is input into the summing amplifier 221010. Thesumming amplifier 221010 compares the proportional voltage signal to amotor speed command signal (which is a voltage signal) provided by amotor controller 221018, and adjusts the motor speed command signal asneeded. For example, if the proportional voltage signal from thefrequency-to-voltage converter 221008 is the same as the motor speedcommand signal provided by the motor controller 221018, no adjustment ofthe motor speed command signal is needed. However, if the proportionalvoltage signal from the frequency-to-voltage converter 221008 isdifferent from the motor speed command signal provided by the motorcontroller 221018 (e.g., less than or greater than), the summationamplifier 221010 will increase or decrease the motor speed commandsignal so that the motor can realize the desired speed of rotation. Theadjusted motor speed command signal is passed to the motor drive circuit221020, which operates to provide a voltage to the motor, where thevoltage varies in accordance with a desired speed of rotation of themotor as called for by the adjusted motor speed command signal. Invarious instances, the motor controller 221018 and/or the motor drivecircuit 221020 are part of the control circuit 221000, or they cancomprise separate circuits in communication with the control circuit22100. In certain instances, the motor controller 221018 and/or themotor drive circuit 221020 are part of a control circuit which includesthe main processor of the surgical instrument.

Further to the above, the control circuit 221000 is configured todiscern between the different acoustic signatures of various electricmotors, gearboxes, and/or drive trains of the surgical instrument usinga single acoustic sensor. In various other instances, the controlcircuit 221000 can comprise a plurality of acoustic sensors 221002. Inat least one such instance, each acoustic sensor 221002 is exclusivelydedicated to pick up the acoustic waves of a single component of thesurgical instrument, such as an electric motor, gearbox, or drive train,for example. In any event, baselines for the respective acousticsignatures of the rotatable components of a surgical instrument can beestablished during the assembly of the surgical instrument, and suchbaselines serve as references for the control circuit 221000 toassociate the sensed acoustic signatures with the correct componentsand, also, determine whether or not the surgical instrument is operatingnormally. Moreover, by utilizing one or more acoustic sensors 221002 inthis way, the speed of a motor and/or gearbox can be sensed/measured,the start of travel by a translatable member can be detected, and/or theend of travel by the translatable member can be detected during use, forexample.

In various instances, further to the above, utilizing acousticinformation allows for the remote sensing of motor speed, therebyeliminating the need for directly coupled sensors and/or encoders, forexample. In various instances, the cost of the acoustic sensor 221002can be considerably less than an encoder and the assembly, wiring, andelectronics to support the encoder. Moreover, the acoustic sensor 221002and the FFT circuit 221006 can be part of a redundant system thatconfirms readings from other systems. Such an arrangement can be usefulfor mitigating risks and can create single point failure tolerantdesigns, for example. Furthermore, as indicated above, the acousticsensor 221002 and the FFT circuit 221006 can provide various indicationsof failure, wear, etc. of the drive components of the surgicalinstrument. Additional details regarding the detection of drive trainfailure can be found, for example, in U. S. patent application Ser. No.15/131,963, entitled METHOD FOR OPERATING A SURGICAL INSTRUMENT, filedApr. 18, 2016, now U.S. Patent Application Publication No. 2017/0296173,the disclosure of which is hereby incorporated by reference in itsentirety. The entire disclosure of U.S. patent application Ser. No.15/043,289, entitled MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILUREIN POWERED SURGICAL INSTRUMENTS, filed on Feb. 12, 2016, now U.S. PatentApplication Publication No. 2017/0231628 is incorporated by referenceherein.

Although the control circuit 221000 was described above in terms of theacoustic sensor 221002, it should be appreciated that other parametersof a surgical instrument can be sensed/measured to provide motor speedcontrol. For example, an accelerometer and/or vibration sensor, forexample, can be utilized in addition to or in lieu of the acousticsensor 221002 to sense/measure acceleration data, vibration data, etc.associated with a motor-driven system of the surgical instrument. Suchdata can be utilized to control the speed of rotation of the motor, asdescribed in greater detail below.

Further to the above, the functionality of the control circuit 221000 isutilized to implement one or more methods for identifying thedegradation and/or failure of the drive components of the surgicalinstrument. Such drive components include, for example, the motor221012, the first gearbox 221014, the second gearbox 221016, and/or thedrive train 221018 which can include a rack and pinion 221022 (see FIG.634 ) arrangement, for example.

FIG. 632 illustrates a method 221100 for identifying the degradation orfailure of components of a surgical instrument. As an initial step,i.e., step 221102, baseline measurements of the respective acousticsignatures of the motor 221012, the first gearbox 221014, the secondgearbox 221016, and/or the drive train 221018 are made. At step 221104,the FFT circuit 221006 produces the frequency component signals whichare representative of the baseline measurements of the respectiveacoustic signatures. This sequence may be repeated any number ofdifferent times for various speed and load conditions. Referring to FIG.633 , a graph 221200 shows, in at least one instance, the frequencycomponent signals representative of the baseline measurements of therespective acoustic signatures broken down by component. Morespecifically, the graph 221200 shows the frequency profile 221012 a forthe motor 221012, the frequency profile 221014 a for the first gearbox221014, the frequency profile 221016 a for the second gearbox 221016,and the frequency profile 221018 a for the drive train 221018. Asillustrated in the composite frequency profile in FIG. 633 , none of thefrequency profiles 221012 a, 221014 a, 221016 a, and 221018 a overlapwith one another; however, circumstances can arise where there is apartial overlap between adjacent frequency profiles. These frequencyprofiles, or their respective component signals, are recorded and storedon one or more memory devices, such as solid state memory devices, forexample, of the control circuit which includes the main processor of thesurgical instrument. The stored frequency profiles can be accessed bythe control circuit 221000. As explained in greater detail below, the“baseline” frequency component signals are utilized to determine if themotor-drive system of the surgical instrument has experienced anydegradation or failure.

After the baseline frequency component signals have been established andrecorded at step 221404, the surgical instrument is thereafter operatedand the frequency profiles of the acoustic signatures associated withsuch operation of the surgical instrument are determined and monitoredduring the operation of the surgical instrument at step 221106. Thefrequency profiles associated with the operation of the surgicalinstrument can be monitored by the control circuit 221000 and/or thecontrol circuit which includes the main processor of the surgicalinstrument. At step 221018, the frequency profiles are converted totheir respective frequency component signals by the FFT circuit 221006.At step 221110, the respective frequency component signals from step221108 are compared to the baseline frequency component signals fromstep 221104 to determine whether any of the components of themotor-driven system have experienced any degradation. This comparisoncan be implemented by the control circuit 221000, by the control circuitwhich includes the main processor of the surgical instrument and/or analgorithm of the surgical instrument, for example. As shown in the graph221300 of FIG. 634 , the frequency component signal of the secondgearbox 221016 indicates possible fatigue and/or damage to the secondgearbox 221016 as it deviates from the baseline established at step221404. It should be understood that a certain amount of deviation fromthe established baseline is to be expected, or normal, and thus notindicative of degradation and/or failure. To this end, the controlcircuit 221000, the control circuit which includes the main processor ofthe surgical instrument and/or the algorithm utilizes one or morepredetermined thresholds for delineating between a non-consequentialdeviation from the baseline and a consequential deviation from thebaseline.

Although the method 221100 was described in the context of determiningthe degradation or failure of the motor 221012, the first gearbox221014, the second gearbox 221016, and/or the drive train 221018, itshould be appreciated that the method 221100 could also be utilized todetermine the degradation or failure of other components of the surgicalinstrument.

FIG. 635 illustrates a method 221400 for identifying the degradation orfailure of the drive components of a surgical instrument. As an initialstep, baseline measurements of the current being drawn by the motor221012 are made over time at step 221402. The baseline currentmeasurements can be made in any suitable manner, such as by a currentsensor circuit, for example, and can provide an indication of the amountof current being drawn by the motor 221012 when the motor-driven systemof the surgical instrument is operating in a normal manner, i.e., whenthe motor 221012, the gearboxes 221014 and 221016, and the drive train221018 have not yet experienced any degradation and/or damage. At step221404, a FFT circuit, which can be similar or identical to the FFTcircuit 221006, produces frequency component signals which arerepresentative of the baseline measurements of the current being drawnby the motor 221012. This sequence may be repeated any number ofdifferent times for various speed and load conditions. As explained ingreater detail below, the “baseline” frequency component signals can beutilized to determine if the motor-drive system of the surgicalinstrument has experienced any degradation or failure.

After step 221404, the current being drawn by the motor 221012 issensed/measured by the current sensor circuit, for example, at step221406, and converted to the respective frequency component signals bythe FFT circuit at step 221408. At step 221410, the respective frequencycomponent signals from step 221408 are compared to the baselinefrequency component signals from step 221404 to determine whether any ofthe components of the motor-driven system have experienced anydegradation. This comparison can be implemented by the control circuit221000, by the control circuit which includes the main processor of thesurgical instrument and/or an algorithm of the surgical instrument, forexample. In various instances, the control circuit 221000, the controlcircuit which includes the main processor of the surgical instrumentand/or the algorithm look for repetitious events on a frequency whichcould be indicative of a spinning failure such as, for example, achipped tooth on a gear of a gearbox.

Referring to FIG. 636 , a graph 221500 shows the baseline measurements221502 (solid line) and the subsequent measurements 221504 (dashed line)of the current drawn by the motor 221102. The graph 221500 also showsthe baseline frequency component signals 221506 (forward slash bars) andthe subsequent frequency component signals 221508 (back slash bars)representative of the baseline measurements and the subsequentmeasurements of the current drawn by the motor 221102. The graph 221500includes two horizontal axes—an “upper” horizontal axis 221510 and a“lower” horizontal axis 220512. The time t is shown along the “upper”horizontal axis 221510, and the frequency Hz is along the “lower”horizontal axis 221512. The graph 221500 also includes two verticalaxes—an “upper” vertical axis 220514 and a “lower” vertical axis 221516.The current is shown along the “upper” vertical axis 220514 and themagnitude of the fast Fourier transforms is shown along the “lower”vertical axis 221516. As discussed below, this information is used bythe control circuit 221000, the control circuit which includes the mainprocessor of the surgical instrument and/or an algorithm of the surgicalinstrument to evaluate repetitive anomalous current draws and/oracoustic events.

Referring again to FIG. 636 , the subsequent current measurementsrepresented by the dashed line 221504 indicate three different instancesof an abnormal event being experienced by the motor 221012. Theseabnormal events comprise spikes in the motor current draw and arerepresented by three peaks in the dashed line 221504. The controlcircuit 221000, the control circuit which includes the main processor ofthe surgical instrument and/or the algorithm operate to differentiatebetween the baseline current draw and the anomalous current draw peaks.In at least one instance, the algorithm determines that an anomalouscurrent draw peak has occurred when the current draw exceeds a thresholddifference relative to the baseline current draw. In various instances,the threshold difference is 50% above the baseline current draw, forexample. In other instances, the threshold difference is 100% above thebaseline current draw, for example, although any suitable threshold canbe used. In various instances, the algorithm can use the motor currentdraw threshold alone to determine whether an anomalous event hasoccurred. In certain instances, the algorithm can use other parametersin addition to the motor current draw threshold for assessing anomalousevents. For instance, the algorithm can use the time between theanomalous events to determine whether or not the anomalous events arerepetitive. If a repeating time period between the repeating events canbe established by the algorithm, then the algorithm can determine thatthere may be degradation and/or damage in one of the rotating componentsin the drive system even though the current peaks do not exceed thethreshold. That said, the lack of an established time period between therepetitive events does not necessarily indicate that degradation and/ordamage hasn't occurred. Instead, in such instances, it can be an earlyindication of degradation and/or damage. In at least one instance, thethreshold for determining whether motor current draws are abnormal islower if a consistent time period between the peaks can be established.Correspondingly, the threshold is higher if a consistent time periodcan't be established.

Notably, the above-discussed anomalous current draws may or may notcorrespond with a corresponding variation in the baseline acousticfrequency profile. For instance, in FIG. 636 , the frequency componentsof the baseline current and the subsequent current are within the normalexpected range during the three motor current spikes discussed above,which is shown in three grouping comparisons 221518 delineated by dashedlines. If, however, there is also an anomalous repetitive event withinthe frequency components that corresponds in time with the measuredmotor current peaks, the algorithm can apply a lower threshold fordetermining anomalous motor current draws indicative of drive componentdegradation and/or damage. The above being said, an anomalous repetitiveevent within the frequency components without corresponding motorcurrent spikes can also be indicative of drive component degradationand/or damage. FIG. 636 depicts such an abnormal additional frequency221520. When the magnitude of the anomalous frequency exceeds apredetermined threshold, the algorithm can determine that degradationand/or damage has occurred. In various instances, the algorithm can usea lower threshold for the frequency magnitude when corresponding motorspikes are present and a higher threshold for the frequency magnitudewhen corresponding motor spikes are not present. As such, the algorithmcan determine that degradation and/or damage has occurred with orwithout corresponding anomalous motor current draws, and vice versa.

Although the method 221400 of FIG. 635 was described in the context ofdetermining the degradation or failure of the motor-driven system basedon a comparison of currents being drawn by the motor 221012, it will beappreciated that similar methods which utilize other comparisons couldalso be utilized to determine the degradation or failure of the drivecomponents of the surgical instrument. For example, a measured motorload could be compared to measured shaft power over time, and changes inlosses between the two can be utilized to identify possible fatigueand/or damage to a component of the motor-drive system of the surgicalinstrument. Additionally, methods similar to those of the method 221100and/or the method 221400 can be utilized for purposes of heat managementwithin a sterile barrier of the surgical instrument.

FIG. 637 illustrates a method 221600 for adjusting a motor controlalgorithm of a surgical instrument. An algorithm refers to aself-consistent sequence of steps leading to a desired result, where a“step” refers to a manipulation of physical quantities, which may takethe form of electrical or magnetic signals capable of being stored,transferred, combined, compared, and otherwise manipulated. In thecontext of the motor control algorithm, the motor control algorithm isutilized to control the speed of a motor of the surgical instrument. Themethod 221600 may be utilized to adjust the motor control algorithm tominimize or limit damage of a drive whenever degradation or failure ofthe drive has been detected. Prior to the start of the method 221600,the method 221100, the method 221400, and/or similar methods can beutilized to detect the degradation and/or damage of the motor-drivensystem.

If degradation or failure is detected, referring again to FIG. 637 , acontrol circuit of the surgical instrument (e.g., the control circuitwhich includes the main processor of the surgical instrument) adjuststhe motor control algorithm to adjust or control the speed of theelectric motor at step 221602 to try to reduce the noise, vibration,and/or wear on a component of the motor-drive system. In variousinstances, the speed control can be adjusted by adjusting the pulsewidth modulation (PWM) duty cycle to speed up or slow down the motorspeed given an experienced torque (load) on the system. Adjusting thePWM duty cycle to increase the voltage of the motor speed command signalprovided by the motor controller operates to increase the voltageapplied to the motor, which in turn operates to increase the motorspeed. Adjusting the PWM duty cycle to decrease the voltage of the motorspeed command signal provided by the motor controller 221018 operates todecrease the voltage applied to the motor, which in turn operates todecrease the motor speed. Decreasing the motor speed allows for theacoustic sensing of the motor-drive system to be moved to lowerfrequency levels. Increasing or decreasing the motor speed can move theoperation of the motor drive system away from the natural resonance, ornatural frequency harmonics, of the motor drive system.

After the PWM duty cycle has been adjusted at step 221602, the motordrive system is checked once again at step 221604 to determine whetheror not any degradation or failure of the motor drive system hasoccurred. The determination can be made by utilizing the method 221100,the method 221400, and/or similar methods. In various instances, suchdeterminations are made on a periodic basis, or on a continuous basis,whenever the motor drive system is in use. If degradation or failure isdetected at step 221604, the control circuit adjusts the motor controlalgorithm to adjust a current limit of the motor controller at step221606 proportionate to the detected wear level of the motor-drivesystem to try to minimize the likelihood of further wear or catastrophicfailure. By lowering the amount of current available to be drawn by themotor, the force or torque applied/delivered by the motor is alsolimited. Thus, by lowering the current limit of the motor controllerproportionate to the detected wear level of the motor drive system, thepower of the motor is decreased commensurate with the detected wearlevel of the motor-drive system.

After the current limit of the motor controller 221108 has been adjustedat step 221606, the motor-drive system is checked once again at step221608 to determine whether or not any degradation or failure of themotor-drive system has been detected. The determination can be made byutilizing the method 221100, the method 221400 or similar methods. Invarious instances, such determinations are made on a periodic basis, oron a continuous basis whenever the motor-drive system is in use.

If degradation or failure is detected at step 221608, the controlcircuit adjusts the motor control algorithm to oscillate adjustment ofthe speed control of the surgical instrument or the current limit of themotor controller at step 221610 to coincide with a detected failingpoint of the motor-drive system to try to compensate for the detecteddamage. For example, if a tooth on a gear has failed, is cracked, or ispartially damaged, the acoustic sensor 221002 could detect the clatterresulting from the damage. The decomposition provided by a fast Fouriertransform circuit, such as the fast Fourier transform circuit 221006,for example, could define the period of the disturbance, and then themotor control algorithm could adjust the current limit of the motorcontroller, the motor speed command signal (a voltage) provided by themotor controller, and/or the PWM duty cycle synchronized to that periodto reduce overall system vibration and further overstress of themotor-driven system.

After the speed control of the surgical instrument and/or the currentlimit of the motor controller has been adjusted in an oscillating mannerat step 221610, the motor drive system is checked once again at step221612 to monitor the degradation and/or failure of the motor drivesystem. This determination can be made by utilizing the method 221100,the method 221400, and/or similar methods. Such determinations are madeon a periodic basis, or on a continuous basis whenever the motor-drivesystem is in use. If additional degradation or failure is detected atstep 221612, the above-described process can repeat itself, and can berepeated any number of times. If degradation or failure is detected atstep 221612 which exceeds a threshold, as described in greater detailbelow, the process may end. Although a specific order of steps has beendescribed for the method 221600, it will be appreciated that the orderof the steps can be different. For example, the current threshold can beadjusted before the speed control is adjusted and/or at the same timethat the speed control is adjusted.

If a motor-driven system failure initiates during a surgical procedurebut the motor-drive system or a component thereof does not entirelyfail, the motor control algorithm can operate to reduce the performanceof the motor-drive system (e.g., speed, capability, load) to allow theclinician to continue without delaying the surgical procedure and allowfor a different surgical instrument to be obtained. Responsive to thepartial failure, the control circuit and/or an algorithm can generateone or more warnings to the user. Such warnings can be in the form of anaudible warning, a visual warning, a tactile warning, and/orcombinations thereof, for example, and can indicate that the surgicalinstrument will experience an impending failure, is being operated in alimp mode, and/or will need to be serviced soon, for example. Thecontrol circuit and/or the algorithm could also include a countdown as apercent of damage, time since damage, and/or performance degradation tohelp the clinician know how much time is remaining until servicing ofthe surgical instrument is required.

Further to the above, the control circuit and/or the algorithm canprovide an assessment regarding the severity of the failure. Theassessment can inform multiple decision outcomes that ensure patientsafety while balancing the delay to the procedure and/or the cost ofusing another surgical instrument, for example. If the severity of thefailure is deemed catastrophic by the control circuit and/or thealgorithm, the control circuit and/or the algorithm can inform theclinician of the determination by an appropriate feedback generator. Ifthe severity of the failure is deemed nearly catastrophic such that aprocedure step cannot be completed, the control circuit and/or thealgorithm can operate to inform the user that the user must pursueappropriate steps to safely release the surgical instrument from thepatient. When the surgical instrument is a motor-driven tissue cuttingstapling instrument, for example, the control circuit and/or thealgorithm can operate to only allow the drive motor to reverse the knifedirection, if possible, and/or revert to manual bailout to retract theknife. If the severity of the failure is deemed severe damage, but notcatastrophic, the control circuit and/or the algorithm can operate toinform the clinician of the damage level and allow the clinician tocomplete the procedure step, but disable use of the surgical instrumentafter the procedure step is complete and the surgical instrument issafely removed from the patient. If the severity of the failure isdeemed damaged, but not severely, the control circuit and/or thealgorithm can operate to inform the clinician that damage has occurredand that functionality of the surgical instrument may be altered, butthat it is possible to continue the procedure beyond the currentprocedural step.

In various instances, the control circuit and/or an algorithm isconfigured to use situational awareness to perform a risk assessment ofa damaged surgical instrument and the remaining procedure steps toinform the clinician of a recommended course of action. In a bariatricprocedure, for example, a surgical stapling and cutting instrument isused to transect and staple a portion of a patient's stomach. Notably,stomach tissue can vary in thickness along the transection and staplingpath. In fact, the tissue thickness variation along this path is usuallyquite predictable. In a revisional bariatric procedure removing agastric band, for example, the first stapling firing of the surgicalstapling and cutting instrument is on the antrum of the stomach, i.e.,where the stomach tissue is thickest. In such instances, as a result,the drive train of the surgical stapling and cutting instrument willlikely experience a high loading, stress, and strain during this firststapling firing. Thus, if the instrument is damaged in some way beforethis first stapling firing, it is possible that the first staplingfiring may further damage, if not catastrophically damage, theinstrument. With this in mind, in various instances, the surgicalinstrument comprises a wireless and/or wired signal transmitter andreceiver that is in communication with a surgical hub system and isconfigured to receive a notification from the surgical hub system thatthe surgical instrument is about to be used in this type of bariatricprocedure. In such instances, the control circuit and/or an algorithm isconfigured to inform the user of the surgical instrument of the damagedcondition of and/or the current damage to the surgical instrument andthe possibility of further damage. Moreover, the control circuit and/orthe algorithm can be configured to limit the current available to theelectric motor so as to reduce the possibility of catastrophic failureand optionally allow the clinician to override the lower current limit.The control circuit and/or algorithm can be further configured tore-evaluate the condition of the drive system of the surgical instrumentafter this first stapling firing for additional damage. If the currentdamage is still below an acceptable threshold, the control circuitand/or the algorithm can allow the subsequent staple firings of thesurgical instrument needed to complete the tissue incision and staplingpath. If the current damage is above the acceptable threshold, thecontrol circuit and/or the algorithm can recommend that the surgicalinstrument be replaced to complete the procedure. Thus, as a result ofdata from the surgical hub system, the instrument is situationally awareof the tissue thickness, density, and/or quality that is about to betransected and stapled. Moreover, the data from the surgical hub systemcan include data regarding previous surgical procedures involving thestomach tissue such as the presence of previous stapling lines, thepresence of the gastric band, and/or tissue scarring which, whentransected and stapled by the instrument, may increase the stress on theinstrument drive system. The control circuit and/or the algorithm canoperate in a similar manner to the above-described process to assess thecurrent degradation or damage of the instrument drive system, notify theclinician of this degradation or damage, and offer options to theclinician as how to proceed further in the surgical procedure.

Additional details regarding situational awareness are described, forexample, in U.S. patent application Ser. No. 15/940,654, entitledSURGICAL HUB SITUATIONAL AWARENESS, filed on Mar. 29, 2018, thedisclosure of which is herein incorporated by reference in its entirety.

In various instances, the condition of the motor-driven system iscommunicated to a surgical hub system on a periodic basis, or on acontinuous basis. Thus, the condition of the motor-driven system priorto a detected failure is known by the surgical hub system. A surgicalhub system is described in more detail in U.S. patent application Ser.No. 15/940,629, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICALSYSTEMS, filed on Mar. 29, 2018, the disclosure of which is herebyincorporated by reference in its entirety. An algorithm, executed by acontrol circuit and/or processor of the surgical hub system, can utilizethe history of the use of the surgical instrument in the current case,the life history of the surgical instrument and the surgical hub'ssituational awareness to more fully diagnose the potential for failureof the surgical instrument in the current case, an actual failure of thesurgical instrument in the current case, and better predict similarfailures in similar surgical instruments used in other cases. It will beappreciated that the knowledge provided by the functionality of thesurgical hub system can provide a better understanding of the failuremode, allow for future failures to be predicted and/or avoided based onthe data and analysis, and provide direction to design improvements ofthe surgical instrument to improve lifecycles and avoid future failures.When the surgical hub system determines a failure of a surgicalinstrument is impending, the surgical hub system can communicate thisinformation to a user of the surgical instrument via a display and/or aspeaker of the surgical hub system.

In various instances, a handle of the surgical instrument can beconfigured to provide the electrical system within the handle withimproved durability and robustness to the surgical environment. Forexample, touch-less controls which can be entirely sealed and whichrequire no force to cause a switch of state can be incorporated into thedesign of the handle. Also, reusable handles can be provided withimproved replaceable switch and control elements.

In many surgical procedures, more than one surgical instrument isutilized to complete the surgical procedure. In many instances, at leasttwo surgical instruments can be positioned within the patient at thesame time, and it is possible for the two surgical instruments to comeinto contact and/or close proximity with one another. In somecircumstances, this does not cause a major concern. In othercircumstances, such as when one of the surgical instruments is anelectrosurgical instrument or an ultrasonic surgical instrument, forexample, it is desirable to keep another surgical instrument from cominginto contact with the electrosurgical instrument or the ultrasonicsurgical instrument.

FIG. 638 illustrates an environment 222000 of a surgical procedure. Theenvironment 222000 includes a first surgical instrument 222002, a secondsurgical instrument 222004, a patient 222006, and a grounding pad 222008in contact with the patient 222006. The first and second surgicalinstruments 222002, 222004 are shown as positioned within the patient222006, i.e., within an abdominal cavity, for example, who is lying onthe grounding pad 220008. The first surgical instrument 222002 can beany of a variety of different surgical instruments. For example, thefirst surgical instrument 222002 can be an endocutter, or a tissuecutting and stapling instrument, comprising a shaft 222010 and an endeffector comprising jaws 222012. An external surface of the shaft 222010and/or the jaws 222012 of the endocutter 222002 includes an electricallyconductive material such as, for example, a stainless steel and/or anyother suitable metal.

The second surgical instrument 222004 is a monopolar instrument whichcan receive high-frequency electrosurgical energy from a source, andapply the high-frequency electrosurgical energy to the patient 222006 ina manner well-known in the art. For example, the high-frequencyelectrosurgical energy is applied by an electrode tip 222013 of thesecond surgical instrument 222004. The source can be, for example, amonopolar generator such as the monopolar generator module 220310 of thesurgical hub 220302. Under normal circumstances, the electrosurgicalenergy applied to the patient 222006 passes through the patient 222006to the grounding pad 220008, where it is then returned back to thesource of the electrosurgical energy via electrical conductors of areturn path (not shown) to complete an electrosurgical electricalcircuit.

Due to the proximity of the first surgical instrument 222002 to thesecond surgical instrument 222004 within the patient 222006 at certaintimes during the surgical procedure, there is a risk that too much ofthe high frequency electrosurgical energy applied to the patient 222006by the second surgical instrument 222004 during the surgical procedurewill be diverted through the patient 222006 to the first surgicalinstrument 222002 owing to the high conductivity of the shaft 222010and/or the jaws 222012 as opposed to the grounding pad 222008 asintended. The closer the first surgical instrument 222002 comes to thesecond surgical instrument 222004 within the patient 222006, the higherthe risk of too much of the high frequency electrosurgical energypassing through the patient 222206 to the first surgical instrument222002. In a worst case scenario, where the electrically conductiveportion of the first surgical instrument 222002 comes into directcontact with the electrode tip of the second surgical instrument 222004,an electrical short-circuit is established from the second surgicalinstrument 222004 directly to the first surgical instrument 222002.

In order to mitigate the chance of too much of the high frequencyelectrosurgical energy passing through the patient 222006 to the firstsurgical instrument 222002, the second surgical instrument 222004 isconfigured to apply a low current to the patient 222006 as a testcurrent prior to the second surgical instrument 222004 applying the fulllevel of electrosurgical energy to the patient 222006. The source of thetest current can be, for example, a monopolar generator such as themonopolar generator module 220310 of the surgical hub 220302. In orderto apply the test current, the second surgical instrument 222004includes electrical terminations 222014 (see FIGS. 639, 640, and 641 )on the shaft 222018 of the second surgical instrument 222004. Theelectrical terminations 222014 are electrically connected to the sourceof the electrosurgical energy, and/or a battery, and can apply the testcurrent to the patient 222006. In a way, the electrical terminations222014 are being utilized as continuity sensors to help determineelectrical continuity along a path from the second surgical instrument222004, through the patient 222006, and to the grounding pad 222008.According to various aspects, the electrical terminations 222014 form aportion of a control circuit of the second surgical instrument 222004,and the control circuit and/or an algorithm can be utilized to apply thetest current to the patient 222006.

The test current may only be applied for a brief period of time, such asfor a few milliseconds, for example, in order to adequately determine ifa sufficient instrument-patient-pad continuity is present as describedabove. According to various aspects, the continuity can be determined bya sensing device incorporated into the grounding pad 222008, a sensingdevice incorporated in the cord or cable of the return path and/or by amonopolar generator such as the monopolar generator module 220310 of thesurgical hub 220302. Moreover, the test current may comprise an amperageof only a few milliamps, for example. If the application of the testcurrent does not indicate the presence of a short circuit or significantshunt between the first surgical instrument 222002 and the secondsurgical instrument 222004, the control circuit operates to allow thesecond surgical instrument 222004 to be provided with the full level ofelectrosurgical energy which can then be applied to the patient 222006.However, if the application of the test current indicates the presenceof a short circuit or significant shunt between the first surgicalinstrument 222002 and second surgical instrument 222004, the controlcircuit operates to prevent the second surgical instrument 222004 frombeing provided with the full level of electrosurgical energy,effectively preventing or locking out the second surgical instrument222004 from applying the full level of electrosurgical energy to thepatient 220006 until the instruments 222002 and 222004 are sufficientlyseparated to eliminate the short circuit or shunt therebetween.According to various aspects, the test current can also be appliedperiodically or continuously throughout a surgical procedure, and theelectrosurgical energy being applied to the patient 222006 during thesurgical procedure can be decreased or even interrupted based on thesensing and/or detection of short-circuits and/or significant shuntsbetween the first surgical instrument 222002 and the second surgicalinstrument 222004.

Referring to FIGS. 639-641 , the signals 222016 shown as being emittedfrom the electrical terminations 222014 are representations of the testcurrent exiting from the electrical terminations 222014. Although theelectrical terminations 222014 are only shown as being positioned on theshaft 222018 of the second surgical instrument 222004, the electricalterminations 222014 are also positioned on the body 222020 of the secondsurgical instrument 222004. Such an arrangement provides for potentialleakage paths from the body 222020 of the second surgical instrument222004 to the shaft 222010 and/or jaws 222012 of the first surgicalinstrument 222002, as well as from the shaft 222018 of the secondsurgical instrument 222004 to the shaft 222010 and/or jaws 222012 of thefirst surgical instrument 222002, for example.

FIG. 642 illustrates a graph 222100 which shows a relationship betweenthe leakage current 222102 of the surgical instrument 222004 and theproximity of other objects in the surgical environment 222000 to thesurgical instrument 222004. The time t is shown along the horizontalaxis 222104 and the leakage current is shown along the vertical axis222106. When nothing but air is within approximately 5 centimeters fromthe second surgical instrument 222004, there is very little, if any,current loss from the second surgical instrument 222004. In fact, thecurrent loss in such instances is below a first threshold which can beinterpreted by the control circuit of the surgical instrument 222004that the surgical instrument 222004 is not in contact with the patientor another surgical instrument. The surgical instrument 222004 furthercomprises a first indicator, such as a light and/or a symbol on a screenof the surgical instrument 222004, for example, in communication withthe control circuit that, when actuated by the control circuit,indicates to the clinician that the surgical instrument 222004 is not ina position in which it can affect the patient tissue and/or short outagainst and/or contact another surgical instrument, for example. In atleast one instance, the first indicator comprises a green LED, forexample.

When the surgical instrument 222004 is moved close to the patient,referring again to FIG. 642 , the leakage current increases above thefirst threshold. In at least one such instance, close can beapproximately 3 cm, for example. The surgical instrument 222004 furthercomprises a second indicator, such as a light and/or a symbol on ascreen of the surgical instrument 222004, for example, in communicationwith the control circuit that is activated by the control circuit whenthe leakage current exceeds the first threshold. In at least oneinstance, the second indicator comprises a yellow LED, for example. Theactuation of the second indicator indicates to the clinician that thesurgical instrument 222004 may be in a position in which it can affectthe patient tissue. Because the leakage current is still below a secondthreshold, however, a third indicator in communication with the controlcircuit, such as a light and/or a symbol on a screen of the surgicalinstrument 222004, for example, is not actuated. In such instances, theclinician can understand that the surgical instrument 222004 is not in aposition to short out against and/or contact another surgicalinstrument, for example. In at least one instance, the third indicatorcomprises a red LED, for example. When the surgical instrument 222004 isin contact with the patient, but not another surgical instrument, theleakage current is above the first threshold but still below the secondthreshold unless the surgical instrument 222004 is moved close toanother surgical instrument, as discussed below.

When the surgical instrument 222004 is moved close to another surgicalinstrument, referring again to FIG. 642 , the leakage current increasesabove the second threshold. In at least one such instance, close can beapproximately 3 cm, for example. In such instances, the control circuitof the surgical instrument 222004 actuates the third indicator. In suchinstances, the clinician can understand that the surgical instrument222004 may be in a position to short out against and/or contact anothersurgical instrument, for example. When the surgical instrument 222004moves even closer to another surgical instrument, such as withinapproximately 1 cm, for example, the current leakage can increasesignificantly. In such instances, the control circuit can produce anaudible warning via a speaker in the surgical instrument 222004 incommunication with the control circuit, for example. Such an audiblewarning could also be created when the surgical instrument 222004contacts the other surgical instrument. If the surgical instrument222004 is moved away from the other surgical instrument and the leakagecurrent decreases, the control circuit will deactivate the audiblewarning. If the leakage current falls below the second threshold, thecontrol circuit will deactivate the third indicator. If the leakagecurrent falls below the first threshold, the control circuit willdeactivate the second indicator. As a result of the above, a cliniciancan understand the positioning of the surgical instrument 222004relative to its environment.

In order to mitigate false warnings of unwanted contact, it isbeneficial to establish thresholds which can be utilized todifferentiate contact between, one, the second surgical instrument222004 and the body of the patient 222006 or a trocar, two, the secondsurgical instrument 222004 and the target tissue of the patient 222006and, three, the second surgical instrument 222004 and the first surgicalinstrument 222002 or another surgical instrument within the environment222000 of the surgical procedure.

FIG. 643 illustrates a graph 222200 which shows the direct current (DC)output voltage 222202 of the test current of the second surgicalinstrument 222004 during a surgical procedure. The time t of thesurgical procedure is shown along the horizontal axis 222204 and thevoltage v of the test current is shown along the vertical axis 222206.At time t₁, the voltage 222202 of the test current crosses a v₁ voltagethreshold 222208 which is indicative of the second surgical instrument222004 coming into contact with the trocar as the second surgicalinstrument 222004 is inserted into the patient. The voltage v of thetest current then spikes upward for a brief period of time as thecontinuity sensors 222014 of the second surgical instrument 222014 arepassing through the trocar. Thereafter, the voltage of the test currentreturns back to the lower level once the sensors 222014 have passedthrough the trocar and the second surgical instrument 222004 is furtherinserted into the patient. At time t₂, the voltage 222202 of the testcurrent crosses a v₂ voltage threshold 222210 which is indicative of thesecond surgical instrument 222004 coming into contact with, or closeapproximation with, the tissue of the patient 222006. The voltage 222202thereafter stays above the v₂ voltage threshold 22210 as the surgicalinstrument 222004 is moved and manipulated relative to the patienttissue. At time t₃, the voltage 222202 of the test current crosses thev₃ voltage threshold 222212, which is indicative of the second surgicalinstrument 222004 coming into contact with, or close approximation with,the first surgical instrument 222004 or another surgical instrumentwithin the environment 222000 of the surgical procedure. The voltage222202 of the test current returns to a lower level as the secondsurgical instrument 222004 is moved away from the adjacent instrument.The v₁ voltage threshold 222208 can be considered aninstrument-to-trocar contact threshold, the v₂ voltage threshold 222210can be considered an instrument-to-target tissue contact threshold, andthe v₃ voltage threshold 222210 can be considered aninstrument-to-instrument contact threshold.

In various instances, a control circuit and/or an algorithm can beutilized to analyze the DC output voltage v on an ongoing or continuousbasis. The control circuit and/or the algorithm takes into account themagnitude of DC output voltage 222202, the slope of the DC outputvoltage 222202, and/or the rate of change of the slope of the DC outputvoltage 222202, for example. Using such data, the control circuit and/orthe algorithm can provide a more accurate indication of when the secondsurgical instrument 222004 actually comes into contact with a trocar orthe body of the patient 222006, the target tissue of the patient 222006,and the first surgical instrument 222002 or another surgical instrumentwithin the environment 222000 of the surgical procedure. The moreaccurate indication provided by the control circuit and/or the algorithmoperates to mitigate false warnings of unwanted contact.

Further to the above, various forms of current leakage or interactioncan occur between two or more surgical instruments in a surgicalenvironment. For example, when a fluid is present around a staplecartridge jaw of an endocutter positioned in a patient, an exposed setof electrical contacts of the endocutter can interfere with the sensingof an adjacent powered dissector. Therefore, it is desirable to senseand monitor the electrical interaction between adjacent powered surgicaldevices. In various instances, the electrical potential of one or morecircuit boards in a surgical instrument and/or the interconnected metalshaft components of a powered surgical instrument can be sensed andmonitored. In certain instances, the electric potential is sensed by thesource of the high frequency electrosurgical power. In at least oneinstance, the electrical potential is sensed by respective sensingdevices of the powered surgical instruments. Based on the sensedelectrical potentials, respective control circuits and/or algorithms ofthe powered surgical instruments can determine if any of the poweredsurgical instruments are bleeding current or have a parasiticinteraction and could be inadvertently exposing the adjacent surgicaldevices to false signals.

FIG. 644 illustrates a powered surgical instrument 222300. The shaft ofthe powered surgical instrument 222300 includes an electrical sensinggrid 222302 and electrical insulation 222304. The electrical sensinggrid 222302 is configured to detect electrical potential relative toground. The electrical insulation 222304 surrounds the electricalsensing grid 222302 and operates to electrically isolate the electricalsensing grid 222302 from the environment which is external to thepowered surgical instrument 222300. In at lest one instance, theelectrical sensing grid 222302 is sealed against the shroud of the shaftto prevent, or reduce the possibility of, fluids contacting the sensinggrid 222302.

FIG. 645 illustrates a graph 222400 which shows the electrical potential222402 associated with the powered surgical instrument 222300 of FIG.644 , in accordance with at least one aspect of the present disclosure.The time t is shown along the horizontal axis 222404 and the electricalpotential v_(ext) is shown along the vertical axis 222406. The low valueof the electrical potential 222402 shown along the bottom left of thegraph 222400 is indicative of some parasitic or exposed current beingpresent between the electrical components which are internal to thepowered surgical instrument 222300. As the powered surgical instrument222300 comes closer to an external electrical source, such as anotherpowered surgical instrument, for example, the electrical potential222402 begins to increase. The electrical potential 222402 increasesmore and more as the powered surgical instrument 222300 gets closer andcloser to the external electrical source. The slope of the increasedelectrical potential, which is represented by the dashed line 222408,can be utilized to indicate the presence and/or proximity of theexternal electrical source. In various instances, a control circuitand/or an algorithm can be utilized to analyze the electrical potential222402, and taking into account the magnitude of the electricalpotential 222402, the slope of the electrical potential 222402, and/orthe rate of change of the slope of the electrical potential 222402, forexample, the control circuit and/or the algorithm can provide anaccurate determination of how close the powered surgical instrument222300 is to an external electrical source.

FIG. 646 illustrates an active transmission and sensing scheme 222500utilized by first and second surgical instruments 222502, 222504. Thefirst surgical instrument 222502 is a “smart” surgical instrument andincludes a transmitter 222506 (which can be a magnetic transmitter) anda receiving circuit 222508 which collectively operate to providemagnetic emission and detection along the shaft 222510 and/or the endeffector 222512 of the first surgical instrument 222502. The firstsurgical instrument 222502 comprises an endocutter including a staplecartridge jaw and an anvil jaw, but can comprise any suitable surgicalinstrument. The second surgical instrument 222504 is a “non-transmissionenabled” surgical instrument and includes first and second sensingdevices 222514, 222516 which are positioned opposite one another on theshaft or body 222518 of the second surgical instrument 222504. Thesecond surgical instrument 222504 comprises a clampable jaw and, inaddition, a blade in communication with a standing vibration transducerconfigured to cut and/or coagulate tissue.

The first sensing device 222514 is positioned on the “blade side” of thesecond surgical instrument 222504 while the second sensing device 222516is positioned on the “jaw side” of the second surgical instrument222504. The first and second sensing devices 222514, 222516 are magneticsensors, for example. By being positioned opposite one another onopposite sides of the shaft or body 222518, the first and second sensingdevices 222514, 222516 allow for the first surgical instrument 222502 todetermine the position and orientation of the second surgical instrument222504 relative to the first surgical instrument 222502.

The transmitter 222506 and the receiving circuit 222508 extend along thelength of the shaft 222510 and/or the end effector 222512 of the firstsurgical instrument 222502. The transmitter 222506 and the receivingcircuit 222508 are positioned within a flexible circuit at any suitablelocation in the shaft 222510 and/or the end effector 222512, and can beactive at the same time, either continuously or intermittently, asdescribed in greater detail below. The transmitter 222506 is configuredto transmit a signal 222519 in the form of a magnetic field which isreflected by the first and second sensing devices 222514, 222516 of thesecond surgical instrument 222504 to form respective return signals222520, 222522, which are also in the form of magnetic fields. Thatsaid, signals other than magnetic fields could be emitted and reflectedin other aspects. The receiving circuit 222508 is configured to receivethe return signals 222520, 222522. According to various aspects, thereceiving circuit 222508 either incorporates or may be considered amagnetic sensing device. In various instances, the receiving circuit222508 is configured to look for a response from the transmitter 222506after the transmitter emits the signal 222519, as also described ingreater detail below.

In various instances, a magnetic power source of the transmitter 222506generates randomly sequenced on-off pulses. Stated another way, themagnetic fields emitted by the transmitter 222506 are not periodic;instead, the magnetic fields are emitted at random times as determinedby a control circuit and/or an algorithm of the first surgicalinstrument 222502. That said, the magnetic fields are emitted at anaverage rate of approximately 10 times per second and at a frequency ofaround 1 kHz, for example. Moreover, the duration of the magnetic fieldpulses are randomized. In between the pulses, the receiving circuit222508 can be switched in and is configured to listen for the returnsignals 222520, 222522. The receiver circuit 222508 receives the returnsignals 222520, 222522 and passes information representative of thereturn signals 222520, 222522 to a control circuit and/or an algorithmof the first surgical instrument 222502. The control circuit may alsohave information representative of the signals 222519 emitted by thetransmitter 222506. Based on the information representative of thesignals 222519 and the information representative of the return signals222520, 222522, the control circuit and/or the algorithm can determinethe position and orientation of the second surgical instrument 222504relative to the first surgical instrument 222502. If, for some reason,the receiver circuit 222508 only receives one of the return signals222520, 222522, the control circuit and/or the algorithm would be ableto determine the position of the second surgical instrument 222504relative to the first surgical instrument 222502, but not itsorientation.

In instances where another magnetic signal-emitting surgical instrumentis present in the surgical field of the first and second surgicalinstruments 222502, 222504, it is likely that the receiver circuit222508 of the first surgical instrument 222502 will receive the magneticsignals of the other signal-emitting surgical instrument. Without more,the control circuit and/or the algorithm may not be able to properlyanalyze the position and/or orientation of the second surgicalinstrument 222504 relative to the first surgical instrument 222502. Sucha situation could be avoided if the other signal-emitting surgicalinstrument emitted its signals at a frequency which can be filtered outby one or more low-pass and/or high-pass filters in the receiver circuit222508. Such a situation could also likely be avoided if the othersignal-emitting surgical instrument also emits a signal in the form of amagnetic field at an average rate of approximately 10 times per secondand at a frequency of around 1 kHz, for example. Owing to the randomnessof the pulse duration and rate of the signals emitted by the firstsurgical instrument 222502 and the other signal-emitting surgicalinstrument, and also to the randomness of switching in the receivercircuit 222508 and a corresponding receiver circuit in the othersignal-emitting surgical instrument, a situation where the magneticemissions from the two signal-emitting surgical instruments are inperfect synchrony is mitigated and/or avoided. Thus, it will beappreciated that the active transmission and sensing scheme 222500described above can also be utilized with two surgical instruments whichboth have active transmission and sensing means.

FIG. 647 illustrates a graph 222600 of signals transmitted and receivedby the first surgical instrument 222502 of FIG. 646 . The transmittedsignals 222602 are representative of the signal transmitted by thetransmitter 222506 and are shown with back slashes. The received signals222604 are representative of the return signals 222520, 222522 and areshown with forward slashes. The time t is shown along the horizontalaxis 222608 and the amplitude of the transmitted and received signals222602, 222604 is shown along the vertical axis 222606. As shown in FIG.647 , the amplitude of each of the transmitted signals 222602 is withina given band relative to the 1 kHz emission frequency. The givenamplitude band is shown as being bounded by the dashed lines 222605A,222605B. That said, the amplitudes of only some of the received signals222604 are within the given band. As described in more detail below, byanalyzing the difference between the transmitted signal 222602 and thereceived signal 222604 of each signal set and the differences betweeneach consecutive signal set, the control circuit and/or an algorithm ofthe first surgical instrument 222502 can determine the proximity andorientation of the second surgical instrument 222504 relative to thefirst surgical instrument 222502.

FIG. 648 illustrates a graph 222700 which shows the proximitymeasurements 222702 of the first sensing device 222514 and the proximitymeasurements 222704 of the second sensing device 222516 of the secondsurgical instrument 222504 relative to the first surgical instrument222502. The proximity measurements 222702 of the first sensing device222514 are shown with back slashes and the proximity measurements 222704of the second sensing device 222516 are shown with forward slashes. Thetime t is shown along the horizontal axis 222706 and the distance incentimeters is shown along the vertical axis 222708. According to thefirst set of “proximity bars” near the left-hand side of the graph222700 taken during a first sample, the second surgical instrument220504 is located somewhere around 10 centimeters relative to the firstsurgical device 222502 at a somewhat angled orientation. According tothe second set of “proximity bars” just to the right of the first settaken during a second sample, the second surgical instrument 220504 issomewhere within 7-9 centimeters of the first surgical device 222502 ata somewhat angled orientation. According to the third set of “proximitybars” just to the right of the second set taken during a third sample,the second sensing device 222516 positioned on the “jaw side” of thesecond surgical instrument 222504 is within 1 centimeter of the firstsurgical device 222502; however, the second surgical instrument 222504is angled at a steep angle relative to the first surgical instrument222502. According to the fourth set of “proximity bars” at theright-hand side of the graph 222700 which were taken during a fourthsample, the first sensing device 222514 positioned opposite the “bladeside” of the second surgical instrument 220504 is within 1 centimeter ofthe first surgical device 222502. As the proximities of both the firstand second sensing devices 222514, 222516 are determined relative to thefirst surgical instrument 222502, it will be appreciated that theorientation of the second surgical instrument 222504 relative to thefirst surgical instrument 222502 is also determined in this manner.

In addition to or in lieu of active sensing, passive sensing such asinductive sensing and/or capacitive sensing, for example, can beutilized to determine the proximity of one surgical instrument relativeto another surgical instrument.

FIG. 649 illustrates a passive sensing scheme 222800 utilized by a firstsurgical instrument 222801 and a second surgical instrument 222804. Thefirst surgical instrument 222802 includes a magnetic transmitter 222806and a transducer 222808. The transducer 222808 is configured to vary itsoutput voltage in response to a magnetic field. The transducer 222808comprises a Hall-effect sensor, but could comprise any suitable sensor.As described in more detail below, the Hall-effect sensor 222808 may beconsidered an inductive proximity sensor. The magnetic transmitter222806 operates to generate a primary magnetic field 222810 whichemanates outwardly from the magnetic transmitter 222806. When the secondsurgical instrument 222804 gets within a certain distance of the firstsurgical instrument 222802, the primary magnetic field 222810 induces acurrent in a conductive material of the second surgical instrument222804. In at least one instance, the shaft and/or a jaw of the secondsurgical instrument 222804, for example, comprises the conductivematerial. The induced current in the conductive material of the secondsurgical instrument 222804 operates to generate a secondary magneticfield 222812 which emanates out from the conductive material of thesecond surgical instrument 222804. The secondary magnetic field 222812tends to oppose the primary magnetic field 222810 and has a weakeningeffect on the primary magnetic field 222810. The net strength of themagnetic field at the Hall-effect sensor 222808, in both an unaffectedcondition (where the second surgical instrument 222804 is so far awayfrom the first surgical instrument 222802 so as to have no effect on theprimary magnetic field 222810) as well as in an affected condition(where the second surgical instrument 222804 is close enough to thefirst surgical instrument 222802 to have an effect on the primarymagnetic field 222810) is sensed by the Hall-effect sensor 222808, whichgenerates an output signal or Hall current representative of thestrength of the net magnetic field at the Hall-effect sensor 222808, andthus of the proximity of the second surgical instrument 222804 to thefirst surgical instrument 222802.

FIG. 650 illustrates the primary magnetic field 222810 in an unaffectedcondition proximate the Hall-effect sensor 222808. When there is noobject close enough to the first surgical instrument 222802 so as tohave an effect on the primary magnetic field 222810, the condition ofthe primary magnetic field 222810 is considered to be in an unaffectedcondition. Thus, the field lines 222814 shown in FIG. 649 may beconsidered representative of an unaffected condition of the primarymagnetic field 222810 and what is expected to be received by a receivingcircuit of the first surgical instrument 222802 absent the presence ofanother instrument.

FIG. 651 illustrates the primary magnetic field 222810 in an affectedcondition proximate the Hall-effect sensor 222808. When an object isclose enough to the first surgical instrument 222802 so as to have aneffect on the primary magnetic field 222810, the condition of theprimary magnetic field 222810 is considered to be in an affectedcondition. The field lines 222816 of the primary magnetic field 222810shown in FIG. 650 , which are different from the field lines 222814 ofFIG. 649 and are shown as broken dashed lines, may be consideredrepresentative of an affected condition of the primary magnetic field222810, and are not what is expected to be received by a receivingcircuit of the first surgical instrument 222802.

FIG. 652 illustrates a graph 222900 which shows the Hall current 222902output by the Hall-effect sensor 222808 of the first surgical instrument222802 of FIG. 649 . The strength of the net magnetic field sensed bythe Hall-effect sensor 222808, whether magnetic field strength H ormagnetic flux density B, is shown along the horizontal axis 222904, andthe current I is shown along the vertical axis 222906. As the strengthof the net magnetic field sensed by the Hall-effect sensor 222808increases, the magnitude of the Hall current 222902 decreases. The highmagnitude of the Hall current 222902 shown along the left-had side ofthe graph 222900 is indicative of no other electrically conductiveobject, such as the second surgical instrument 222804, for example,being in close proximity to the first surgical instrument 222802. Thedecrease in the magnitude of the Hall-current between the 1 and the 2 ofthe magnetic field strength is indicative of the second surgicalinstrument 222804 being at some distance from the first surgicalinstrument 222802. The further decrease in the magnitude of theHall-current between the 2 and the 3 of the magnetic field strength isindicative of the second surgical instrument 222804 approaching thefirst surgical instrument 222802. The even further decrease in themagnitude of the Hall-current between the 3 and the 4 of the magneticfield strength is indicative of the second surgical instrument 222804being at close proximity to the first surgical instrument 222802. TheHall current can be passed to a control circuit of the first surgicalinstrument 222802, and the control circuit and/or an algorithm cananalyze the magnitude of the Hall current, the slope of the Hallcurrent, and/or the rate of change of the slope of the Hall current, forexample, to provide an indication of the proximity of the first surgicalinstrument 222802 to the second surgical instrument 222804.

FIGS. 653 and 654 illustrate a passive sensing scheme 223000 utilized bya first surgical instrument 223002 and a second surgical instrument223004. In this passive sensing scheme 223000, the first surgicalinstrument 223002 includes first and second capacitor plates 223006,223008 housed in a sensing head of the first surgical instrument 223002.In a parallel-plate capacitor arrangement like the one shown in FIGS.653 and 654 , when a voltage is applied between the first and secondcapacitor plates 223006, 223008, a uniform electric field is createdbetween the first and second capacitor plates 223006, 223008. Thestrength of the electric field is directly proportional to the voltageapplied and inversely proportional to the distance between the first andsecond capacitor plates 223006, 223008. When there is no object closeenough to the first surgical instrument 223002 so as to have an effecton the electric field, the condition of the electric field is consideredto be in an unaffected condition. Thus, the field lines 223010 shown inFIG. 653 may be considered representative of an unaffected condition ofthe electric field and what is expected to be received by a receivingcircuit of the first surgical instrument 223002.

When an object is close enough to the first surgical instrument 222802so as to have an effect on the electric field, the condition of theelectric field is considered to be in an affected condition. As anotherelectrically conductive object, such as the second surgical instrument223004, for example, approaches the first surgical instrument 223002 asshown in FIG. 654 , the capacitance associated with the first and secondcapacitor plates 223006, 223008 of the first surgical instrument 223002increases. The increased capacitance is shown conceptually by theadditional field lines 223012 in FIG. 654 , and the electric field inFIG. 654 is different from the electric field in FIG. 653 . The electricfield shown in FIG. 654 may be considered representative of an affectedcondition of the electric field, and is not what is expected to bereceived by a receiving circuit of the first surgical instrument 223002absent the presence of another surgical instrument. According to variousaspects, a sensing device such as a capacitive sensor can sense thecapacitance and generate an output signal representative of the sensedcapacitance. The output signal can be converted to a voltage signalwhich is representative of the sensed capacitance, and the voltagesignal can be passed to a control circuit of the first surgicalinstrument 223002. Based on the voltage signals which are representativeof the sensed capacitance, the control circuit and/or an algorithm canmonitor the sensed capacitances, and analyze the change in thecapacitance and/or the change in the electric field to provide anindication of the proximity of the first surgical instrument 223002 tothe second surgical instrument 223004. The capacitive sensor can thus beconsidered a capacitive proximity sensor.

In various aspects, instead of utilizing inductive proximity sensing orcapacitive proximity sensing as described above, a surgical instrumentmay utilize a different proximity sensing scheme. FIG. 655 illustrates asurgical instrument 223100 which includes a direct current (DC) powersource 223102, an oscillator 223104, a coil 223106, and a current sensor223108. The DC power source 223102 provides direct current (DC) power tothe oscillator 223104. The oscillator 223104 is configured to convertthe direct current (DC) power to an alternating current (AC) signalwhich is passed to the coil 223106. As the alternating current is fed tothe coil 22306, the coil 223106 generates a changing magnetic field223110 which induces a current in the coil 223106. The current from thecoil 223106 is sensed/measured by the current sensor 223108. As anelectrically conductive object, such as another surgical instrument, forexample, approaches the surgical instrument 223100, the other surgicalinstrument can affect the strength of the magnetic field 223110, whichin turn affects the magnitude of the induced current. Bysensing/measuring the induced current, a control circuit and/or analgorithm of the surgical instrument 223100 can determine when anotherobject is approaching and/or is in close proximity.

FIG. 656 illustrates a graph 223200 which shows the induced current223202 measured by the current sensor 223108 of the surgical instrument223100 of FIG. 655 , in at least one instance. The time t is shown alongthe horizontal axis 223204, and the current I is shown along thevertical axis 223206. When the magnitude of the induced current 223202is relatively constant as shown for the period of time shown on theleft-hand side of FIG. 656 , the induced current 223202 is indicative ofa situation where no other object/surgical instrument is approaching orproximate to the surgical instrument 223100. When the magnitude of theinduced current 223202 is increasing as shown for the period of timeshown on the right-hand side of FIG. 656 , the induced current 223202 isindicative of a situation where another object/surgical instrument isapproaching and/or proximate to the surgical instrument 223100. Acontrol circuit and/or an algorithm of the surgical instrument 223100can analyze the magnitude of the measured current, the slope of themeasured current, and/or the rate of change of the slope of the measuredcurrent, for example, to provide an indication of the proximity of thesurgical instrument 223100 to another electrically conductiveobject/surgical instrument.

There are many surgical instruments which include electrical componentsin the end effector and/or shaft of the surgical instrument. In certainsurgical procedures, a surgical instrument being utilized can come intocontact with various liquids which are either from the patient orintroduced into the patient during the surgical procedure. In somecases, the liquid can come into contact with the electrical componentsin the end effector and/or shaft of the surgical instrument. When thisoccurs, the performance of the electrical components, and thus theperformance of the surgical instrument, can be affected to varyingdegrees. The degradation of the performance of the electrical componentsand/or the surgical instrument due to the exposure to the liquid isoften referred to as liquid contamination.

In some instances, when liquid contamination occurs, the electricalcomponents can still perform their primary function, but not necessarilyas well as would be possible otherwise. In other instances, one or moreof the electrical components can no longer perform their primaryfunction, which can lead to the failure of the surgical instrument. Dueto the potential performance issues associated with liquidcontamination, it is desirable to sense and detect liquid contaminationof an electrical component of a surgical instrument, and take actions toadjust for the liquid contamination.

FIG. 657 illustrates a surgical instrument 223300 including an endeffector 223302, a shaft 223304, a sensing array which includes a firstpair of sensing devices 223306A, 223306B and a second pair of sensingdevices 223308A, 223308B, and a fluid detection circuit 223310. Thesurgical instrument 223300 also includes an electrically insulativematerial 223312 and an absorption material 223314. The shaft 223304includes one or more openings 223316 through an external housing/shroud223318 of the shaft 223304 which may allow for fluid and/or othercontaminants 223320 to pass from an environment which is external to theshaft 223304 to a position within the shaft 223304.

The first pair of sensing devices 223306A, 223306B and the second pairof sensing devices 223308A, 223308B are positioned within the shaft223304 and are surrounded by the shroud 223318 of the shaft 223304. Asshown in FIG. 657 , the sensing device 223306A is spaced apart from thesensing device 223306B, the sensing device 223308A is spaced apart fromthe sensing device 223308B, and the first and second pairs of sensingdevices 223306A, 223306B, 223308A, 223308B are spaced apart from oneanother. Each of the sensing devices 223306A, 223306B, 223308A, 223308Bis connected to the fluid detection circuit 223310. Based on theconfiguration of the first and second pairs of sensing devices 223306A,223306B, 223308A, 223308B, the sensing devices 223306A, 223306B,223308A, 223308B and their respective connection paths to the fluiddetection circuit 223310 may be considered a ladder circuit, where two“rungs” of the ladder are represented by the respective first and secondpairs of sensing devices 223306A, 223306B, 223308A, 223308B and the two“rails” of the ladder are represented by their respective connectionpaths to the fluid detection circuit 223310. Although only two pairs ofsensing devices are shown in FIG. 657 , it will be appreciated that thesurgical instrument 223300 may include any number of pairs of sensingdevices which are spaced apart from one another and connected to thefluid detection circuit 223310 in a manner like the first and/or secondpair of sensing devices 223306A, 223306B, 223308A, 223308B, and/or anyother suitable manner.

The sensing devices 223306A, 223306B, 223308A, 223308B compriseconductivity electrodes which are electrically insulated from each otherby the electrically insulative material 223312. The electricallyinsulative material 223312 can include four or more openingscorresponding to the positions of the sensing devices 223306A, 223306B,223308A, 223308B which allow for fluid within the shaft 223304 to passtherethrough and come into contact with the sensing devices 223306A,223306B, 223308A, 223308B. When the first pair of the sensing devices223306A, 223306B are electrically isolated from one another owing to anabsence of fluid between the sensing devices 223036A and 223306B, thefluid detection circuit 223310 outputs a signal which is indicative ofthe interior volume of the shaft 223304 being dry enough for the normaloperation of the surgical instrument 223300. The signal is then passedto a control circuit (not shown) of the surgical instrument 223300,where the signal is interpreted as being indicative of a condition wherethe interior volume of the shaft 223304 is sufficiently dry as to allowfor the normal operation of the surgical instrument 223300. The controlcircuit can include a shaft processing circuit and/or a handleprocessing circuit which includes a main processor of the surgicalinstrument 223300. Alternatively, the fluid detection circuit 223310 maynot output a signal when the first pair of the sensing devices 223306A,223306B, are electrically isolated from one another, and the controlcircuit may interpret this lack of a signal as being indicative of acondition where the interior volume of the shaft 223304 is sufficientlydry as to allow for the normal operation of the surgical instrument223300.

When the fluid within the shaft 223304 is of a sufficient volume whichallows for the first pair of sensing devices 223306A, 223306B to beelectrically connected to one another via the fluid, the fluid detectioncircuit 223310 recognizes the electrical connection between the firstpair of sensing devices 223306A, 223306B and outputs a signal which isindicative of a liquid contamination condition proximate the positionsof the first pair of sensing devices 223306A, 223306B. The signal isthen passed to the control circuit. Responsive to the liquidcontamination signal, the control circuit issues one or more controlsignals which serve to adjust the operation of the surgical instrument223300. For example, the control circuit can issue one or more controlsignals which serve to lower the amount of power available to thesurgical instrument 223300, lock out or disable one or more functions ofthe surgical instrument 223300, and/or lock out or disable one or moreelectrical traces which are susceptible to signal loss orshort-circuiting, for example. Also, for example, the fluid detectioncircuit 223310 may not output a signal when the sensing devices 223306A,223306B are electrically connected to one another via the fluid, and thecontrol circuit may interpret this lack of a signal as being indicativeof a liquid contamination condition. The electrical connection betweenthe sensing devices 223306A, 223306B provides an indication whether ornot the fluid has intruded a first distance into the surgical instrument223300, where the first distance corresponds to the positions of thesensing devices 223306A, 223306B within the shaft 223304.

When the second pair of the sensing devices 223308A, 223308B areelectrically isolated from one another, the fluid detection circuit223310 can output a signal which is indicative of the interior volume ofthe shaft 223304 being dry enough for continued operation of thesurgical instrument 223300. The signal is then passed to the controlcircuit of the surgical instrument 223300, where the signal isinterpreted as being indicative of a condition where the interior volumeof the shaft 223304 proximate the positions of the sensing devices223308A, 223308B is sufficiently dry as to allow for the continuedoperation of the surgical instrument 223300. Alternatively, the fluiddetection circuit 223310 may not output a signal when the second pair ofthe sensing devices 223308A, 223308B, are electrically isolated from oneanother, and the control circuit may interpret this lack of a signal asbeing indicative of a condition where the interior volume of the shaft223304 is sufficiently dry as to allow for the continued operation ofthe surgical instrument 223300.

When the fluid within the shaft 223304 is of a sufficient volume whichallows for the second pair of sensing devices 2233086A, 223308B to beelectrically connected to one another via the fluid, the fluid detectioncircuit 223310 recognizes the electrical connection between the secondpair of sensing devices 223308A, 223308B and outputs a signal which isindicative of a liquid contamination condition proximate to thepositions of the sensing devices 2233086A, 223308B. The signal is thenpassed to the control circuit. Responsive to the liquid contaminationsignal, the control circuit issues one or more control signals whichserve to adjust the operation of the surgical instrument 223300. Forexample, the control circuit can issue one or more control signals whichserve to lower the amount of power available to the surgical instrument223300, lock out or disable one or more functions the surgicalinstrument 223300, and/or lock out or disable one or more electricaltraces which are susceptible to signal loss or short-circuiting, forexample. Alternatively, the fluid detection circuit 223310 may notoutput a signal when the sensing devices 223308A, 223308B areelectrically connected to one another via the fluid, and the controlcircuit may interpret this lack of a signal as being indicative of aliquid contamination condition. The electrical connection between thesensing devices 223308A, 223308B provides an indication whether or notthe fluid has further intruded to a second distance into the surgicalinstrument 223300, where the second distance corresponds to thepositions of the sensing devices 223308A, 223308B within the shaft223304.

In various instances, the sensing devices 223306A, 223306B, 223308A,223308B, the electrically insulative material 223312, and/or the fluiddetection circuit 223310 can form portions of a flex circuit 223322which is positioned within the shaft 223004 and can conform to theinterior surface of the external housing or shroud 223318 of the shaft223004. That said, the sensing devices 223306A, 223306B, 223308A,223308B, the electrically insulative material 223312, and/or the fluiddetection circuit 223310 can be arranged in any suitable manner.

The absorption material 223314 is configured to absorb the fluid withinthe shaft 223004. By absorbing the fluid, the absorption material 223314slows the ingress of the fluid into the surgical instrument 223300;however, the fluid will ultimately wick through the absorption material223314 toward the second pair of sensing devices 223308A, 223308B.Notably, the first pair of sensing devices 223306A, 223306B arepositioned distally with respect to the absorption material 223314 and,as a result, any initial fluid intrusion will quickly reach the firstpair of sensing devices 223306A, 223306B. On the other hand, at least aportion of the absorption material 223314 is present between the firstpair of sensing devices 223306A, 223306B and the second pair of sensingdevices 223308A, 223308B and, as a result, the fluid intrusion may ormay not reach the second pair of sensing devices 223308A, 223308B. As aresult, the fluid detection circuit 223310 is configured to use theelectrical connection between the first pair of sensing devices 223306A,223306B as a fluid intrusion/contamination warning which does notnecessarily change any operation of the surgical instrument 223300, andto use the electrical connection between the second pair of sensingdevices 223308A, 223308B as a fluid intrusion/contamination warningwhich does change the operation of the surgical instrument 223300.

As shown in FIG. 657 , the absorption material 223314 may be configuredin the form of a ring or cylinder which is concentric with the externalhousing/shroud 223318 of the shaft 223004. The second pair of sensingdevices 223308A, 223308B are positioned between the absorption material223314 and the external housing/shroud 223318 which further limits andcontrols the potential ingress of the fluid into the surgical instrument223300.

In various instances, the above-described sensing array and/or anothersimilar sensing array can be used in concert with the absorptionmaterial 223314 to not only detect the presence of fluid within theshaft 223304, but also to detect when the fluid has reached an amountwhich can no longer be adequately handled by various electricalcomponents of the surgical instrument 223300. Stated differently, thiscombination can help determine how much fluid is in the shaft 223304. Itwill be appreciated that some electrical components of the surgicalinstrument 223300 can perform their primary function better than otherelectrical components of the surgical instrument 223300 can when bothare exposed to the same volume of fluid. Similarly, some electricalcomponents of the surgical instrument 223300 will fail before otherelectrical components of the surgical instrument 223300 will fail whenboth are exposed to the same volume of fluid.

FIG. 658 illustrates an electrical circuit 223400 of the surgicalinstrument 223300 of FIG. 657 . The electrical circuit 223400, or atleast a portion of the electrical circuit 223400, can be positionedwithin the absorption material 223314 of the surgical instrument 223300and can be utilized to determine when fluid in the shaft 223004 hasreached a volume which can no longer be adequately handled by one ormore electrical components of the surgical instrument 223300. Theelectrical circuit 223400 includes a sensing array which includes afirst pair of sensing devices 223402A, 223402B and a second pair ofsensing devices 223404A, 223404B. The first and second pairs of sensingdevices 223402A, 223402B, 223404A, 223404B can be the first and secondpairs of sensing devices 223306A, 223306B, 223308A, 223308B shown inFIG. 657 , respectively, or additional sensing devices. Thus, it shouldbe appreciated that the electrical circuit 223400 can form a part of theflexible circuit 223322 and can also be electrically connected to thefluid detection circuit 223310.

The electrical circuit 223400 also includes a first comparator 223406which is electrically connected to the first pair of sensing devices223402A, 223402B, and a second comparator 223408 which is electricallyconnected to the second pair of sensing devices 223404A, 223404B. Asexplained in greater detail below, the first and second comparators223406, 223408 are utilized to determine whether an input has reachedsome predetermined value. In various instances, the first and secondcomparators 223406, 223408 are realized with operational amplifiers. Incertain instances, the first and second comparators 223406, 223408 arerealized with a dedicated comparator integrated circuit. The electricalcircuit 223400 further includes a first resistive element 223410 whichis electrically connected to the first pair of sensing devices 223402A,223402B, and a second resistive element 223412 which is electricallyconnected to the second pair of sensing devices 223404A, 223404B.

Based on the configuration of the first and second pairs of sensingdevices 223402A, 223402B, 223404A, 223404B and their respectiveconnection paths back to the power source V, at least part of theelectrical circuit 223400 may be considered a ladder circuit, where tworungs of the ladder are represented by the respective first and secondpairs of sensing devices 223402A, 223402B, 223404A, 223404B and the tworails of the ladder are represented by their respective connection pathsback to the power source V. Although only two pair of sensing devicesare shown in FIG. 658 , it should be appreciated that the electricalcircuit 223400 may include any number of pairs of sensing devices, whichare spaced apart from one another and connected to the power source V ina manner like the first and/or second pair of sensing devices 223402A,223402B, 223404A, 223404B, as well as any number of correspondingcomparators.

In operation, when a sufficient amount of fluid within the shaft 223004causes the first pair of sensing devices 223402A, 223402B to beelectrically connected to one another via the fluid, the first pair ofsensing devices 223402A, 223402B provide a voltage signal to a firstinput (e.g., the negative−input) of the first comparator 223406. Thefirst comparator 223406 then compares the voltage signal from the firstpair of sensing devices 223402A, 223402B with a reference voltage whichis connected to a second input (e.g., the positive+input) of the firstcomparator 223406. Based on which voltage is larger, the firstcomparator 223406 then outputs either a “high” signal or a “low” signal.For example, when the reference voltage is greater than the voltagesignal from the first pair of sensing devices 223402A, 223402B, thefirst comparator 223406 outputs a “low” signal which is an indicationthat the volume of fluid within the shaft 223004 proximate to the firstpair of sensing devices 223402A, 223402B has not yet reached a levelthat cannot be adequately handled by the electrical components of thesurgical instrument 223300. This would also be the case when the sensingdevices 223402A, 223402B are electrically isolated from one another. Onthe other hand, when the voltage signal from the first pair of sensingdevices 223402A, 223402B, is greater than the reference voltage, thefirst comparator 223406 outputs a “high” signal which is an indicationthat the amount of fluid proximate to the first pair of sensing devices223402A, 223402B has reached a level within the shaft 223304 which canno longer be adequately handled by one or more electrical components ofthe surgical instrument 223300. In either case, the signal output by thefirst comparator 223406 may be passed to the control circuit of thesurgical instrument 223300 for further action.

Similarly, when the absorption material 223314 has absorbed a sufficientamount of fluid from within the shaft 223004 to cause the second pair ofsensing devices 223404A, 223404B to be electrically connected to oneanother via the absorbed fluid, the second pair of sensing devices223404A, 223404B provide a voltage signal to a first input (e.g., thenegative−input) of the second comparator 223408. The first comparator223408 then compares the voltage signal from the second pair of sensingdevices 223404A, 223404B with a reference voltage which is connected toa second input (e.g., the positive+input) of the second comparator223408. Based on which voltage is larger, the second comparator 223408then outputs either a “high” signal or a “low” signal. For example, whenthe reference voltage is greater than the voltage signal from the secondpair of sensing devices 223404A, 223404B, the second comparator 223408outputs a “low” signal which is an indication that the volume of fluidwithin the shaft 223004 has not yet reached a level that cannot beadequately handled by the electrical components of the surgicalinstrument 223300. This would also be the case when the sensing devices223404A, 223404B are electrically isolated from one another. On theother hand, when the voltage signal from the second pair of sensingdevices 223404A, 223404B, is greater than the reference voltage, thesecond comparator 223408 outputs a “high” signal which is an indicationthat the amount of fluid absorbed by the absorption material 223314 hasreached a saturation level, which is an indication that the volume offluid within the shaft 223004 can no longer be adequately handled by oneor more electrical components of the surgical instrument 223300. Ineither case, the signal output by the second comparator 223408 may bepassed to the control circuit of the surgical instrument 223300 forfurther action.

Responsive to a “high” output signal from the first comparator 223406and/or the second comparator 223408, the control circuit can issue oneor more control signals which serve to issue a signal degradationwarning, issue a component and/or sub-system failure warning, lower theamount of power available to the surgical instrument 223300, lock out ordisable one or more functional features of the surgical instrument223300, and/or lock out or disable one or more electrical traces whichare susceptible to signal loss or short-circuiting, for example.

Although the same reference voltage is shown in FIG. 658 as beingapplied to the first comparator 223406 as well as to the secondcomparator 223408, it will be appreciated that a first reference voltagecan be applied to the first comparator 223406 and a second referencevoltage can be applied to the second comparator 223408, where the firstand second voltage references are different from one another. Forexample, if the first reference voltage is lower than the secondreference voltage, the output signal from the first comparator 223406can provide an indication that a “level 1” fluid contamination level hasbeen reached in the shaft 223004 where electrical signals are degradedand/or the performance of at least one electrical component of thesurgical instrument 223000 is in danger of being affected, and theoutput signal from the second comparator 223408 can provide anindication that a “level 2” fluid contamination level has been reachedin the shaft 223004 where electrical signals are even further degradedand/or the performance of at least one other electrical component of thesurgical instrument 223000 is in danger of being affected. Based on thedifferent meanings of the output signals passed to the control circuitof the surgical instrument 223300, the control circuit can issue controlsignals which serve to adjust the operations of the surgical instrument223300 differently and/or adjust different operations of the surgicalinstrument 223000. For example, when a “level 1” fluid contaminationlevel signal is output from the first comparator 223406, the controlcircuit issues one or more control signals which serve to lower theamount of power available to the surgical instrument 223300. When a“level 2” fluid contamination level signal is output from the secondcomparator 223408, the control circuit issues one or more controlsignals which serve to further lower the amount of power available tothe surgical instrument 223300, lock out or disable one or morefunctional features of the surgical instrument 223300, and/or lock outor disable one or more electrical traces which are susceptible to signalloss or short-circuiting, for example.

Furthermore, although the sensing devices 223402A, 223402B, 223404A,223404B are shown in FIG. 658 as being in an “open” position (e.g., notelectrically connected to one another), the above-describedfunctionality of the electrical circuit 223400 can also be realized withthe sensing devices 223402A, 223402B, 223404A, 223404B being in a“closed” position. As long as the sensing devices 223402A, 223402B,223404A, 223404B remain in the “closed” position and pass respectivevoltage signals to the first and second comparators 223406, 223408, theoutput signals of the first comparator 223406 and/or the secondcomparator 223408 would be an indication that the volume of fluid withinthe shaft 223004 has not yet reached a level that cannot be adequatelyhandled by the electrical components of the surgical instrument 223300.As more and more fluid comes into the shaft 223004 and is absorbed bythe absorption material 223314, the absorption material 223314 furtherexpands, eventually reaching the point where the electrical connectionbetween the second pair of sensing devices sensing 223404A, 223404B isbroken/pulled apart, thereby breaking/altering the electricalcontinuity/conductivity within the electrical circuit 223400. Thebreaking/altering in the continuity/conductivity changes the respectivevoltage signals applied to the first inputs (e.g., the negative−inputs)of the first and second comparators 223406, 223408, which in turnchanges the meaning of the signals output by the first and secondcomparators 223406, 223408.

When a surgical instrument is used during a surgical procedure, thedensity of the air associated with the environment in which the surgicalprocedure is taking place can have an effect on the performance of thesurgical instrument. In most case, the altitude the surgical procedureis taking place at can be a proxy for the air density. For example, asurgical instrument being used in a high altitude location where the airis generally less dense than at sea level can perform differently thanwhen the surgical instrument is used at or near sea level. Due toperformance issues associated with air density/altitude, it is desirableto sense/detect the air density/altitude which the surgical instrumentis operating at, and adjust various thresholds, control parametersand/or sensed values to compensate for differences in altitude.

Heat dissipation within a surgical instrument is one performancecharacteristic which changes with altitude. As the altitude increases,there is less air for a given volume and, as a result, the atmosphericpressure decreases. As the atmospheric pressure decreases, air moleculesspread out further and the temperature decreases. There are certainparts of a surgical instrument which rely on convection cooling todissipate heat generated by the operation of the surgical instrument.With convection cooling, the heat generated by the operation of thesurgical instrument is transferred from the surgical instrument to theair surrounding the surgical instrument. At higher altitudes, where theatmospheric pressure is lower and there is less air (the air density islower), the convection cooling is less efficient due to there being lessair, and it is more difficult to dissipate the waste heat generated bythe electronics of the surgical instrument which drive motors, generatehigh frequency electrosurgical energy for radio-frequency (RF), and/orultrasonic type applications, for example, due to the convection coolingbeing less efficient. This is why motor heat dissipation efficiencydecreases with increasing altitudes.

Air volume delivered by a compressor pump in a smoke evacuation systemutilized with a surgical procedure is another performance characteristicwhich changes with altitude. The compressor pump will deliver the samevolume of air regardless of the weight or density of the air (asaltitude increases, the weight and density of the air becomes lower andlower). However, since the weight of the air is lower at higheraltitudes, the compressor pump requires less electrical power to deliverthe same volume of air at higher altitudes. Stated differently, todeliver a given volume of air at a higher altitude, the motor speed ofthe compressor pump can be decreased. That said, to deliver a givenweight of air at a higher altitude, the motor speed of the compressorpump is increased.

In view of the above, it will be appreciated why it is desirable tosense/detect the altitude (as a proxy for the air density) which thesurgical instrument is operating at, and adjust various thresholds,control parameters and/or sensed values to compensate for differences inaltitude. The altitude can be sensed/detected in a number of differentways. For example, the surgical instrument can include a sensing devicewhich senses and measures atmospheric/barometric pressure, such as abarometric pressure sensor, for example. The sensed atmospheric pressureis a proxy for the altitude. Based on the sensed atmospheric pressure, acontrol circuit and/or algorithm of the surgical instrument can issueone or more control signals which operate to alter/adjust the normaloperation of the surgical instrument to account for the altitude/airdensity. In addition to or in lieu of taking direct readings of theatmospheric pressure, the surgical instrument can include a globalpositioning system (GPS) receiver which determines the precise positionof the receiver. In such instances, the control circuit and/or algorithmcan correlate the GPS readings with a GPS location, the known altitudeand average atmospheric barometric readings at the GPS location, andissue one or more control signals to alter/adjust the normal operationof the surgical instrument to account for the altitude/air density atthat location. There are also several ways to estimate/calculate ade-rating factor which can be applied to the various thresholds, controlparameters and/or sensed values to account for changes in altitude/airdensity.

FIG. 659 illustrates a graph 223500 which shows relationships betweenaltitude, atmospheric pressure 223502 and electrical power 223504utilized by a surgical instrument, in various instances. The graph223500 can be utilized to determine de-rating factors corresponding todifferent sensed/detected altitudes, where the altitudes are proxies fordifferent air densities. The altitude is shown along a first horizontalaxis 223506 as elevation from sea level. A second horizontal axis 223508is aligned with the first horizontal axis 223506 and also represents theelevation from sea level. A power percentage is shown along a firstvertical axis 223510 and a scaled atmospheric pressure is shown along asecond vertical axis 223512. As shown in FIG. 659 , as the elevationincreases, the atmospheric pressure 223502 decreases and the electricalpower 223504 utilized by the surgical instrument decreases. At sea level(elevation=0), the atmospheric pressure 223502 is at the scaled level of1, and the electrical power 223504 is at 100% power (full power). At anelevation of 10,000 feet above sea level, the atmospheric pressure223502 is at the scaled level of approximately 0.20, and the electricalpower 223504 is at 70% power (30% less than full power). Stateddifferently, at an atmospheric pressure 223502 associated with anelevation of 10,000 feet above sea level, temperature thresholdsassociated with the surgical instrument can be de-rated by 30%. Similarde-rating percentages can be determined for other elevations by simplydetermining where a vertical line aligned with a given elevation on thefirst horizontal axis 223506 crosses the electrical power 223504 and theatmospheric pressure 223502. In various instances, the de-ratingpercentages can be stored as a look-up table in a memory device of acontrol circuit of the surgical instrument, and can be utilized by thecontrol circuit and/or an algorithm to apply de-rating factors to thevarious thresholds, control parameters and/or sensed values to accountfor the sensed/detected air densities.

Another method for determining de-rating factors and/or other applicableadjustments for differences in altitude can be found, for example, in awhite paper entitled A METHOD FOR APPROXIMATING COMPONENT TEMPERATURESAT ALTITUDE CONDITIONS BASED ON CFD ANALYSIS AT SEA LEVEL CONDITIONSauthored by Bruno Zoccali, the disclosure of which is herebyincorporated by reference in its entirety. The white paper was publiclyavailable on the website of TDMG Inc. (www.tdmginc.com) as of Dec. 6,2018.

The surgical instruments disclosed herein are configured to includetemperature sensors positioned within a handle assembly and/or a shaftof the surgical instrument. The surgical instrument can be any of thesurgical instruments described herein. The temperature sensors arepositioned to sense the temperature of certain components and/orsub-systems positioned within the handle assembly and/or the shaft ofthe surgical instrument. For example, the temperature sensors may bepositioned to sense the temperature of an electric motor, powercircuitry, and/or communication circuitry, for example. The sensedtemperatures may be utilized by a control circuit of the surgicalinstrument, such as a main processor in a handle assembly of thesurgical instrument, for example, and/or an algorithm to adjust/adaptthe operation of the surgical instrument.

In various instances, thermal sensing devices can be built into flexcircuits within different parts of the surgical instrument, and thetemperatures measured/sensed by the thermal sensing devices can beutilized by the control circuit and/or an algorithm to determine if atemperature of a given component and/or sub-system is in a warning ordanger zone. Once the sensed/measured temperature of a given componentand/or sub-system is determined to be above the warning level, thecontrol circuit and/or the algorithm can further operate to beginreducing the level of power supplied to the highest heat creatingcomponents and/or systems. For example, the level of power supplied tothe drive motor of the surgical instrument can be reduced.

Once the sensed/measured temperature of a given component and/orsub-system is determined to be over a predetermined critical threshold,the control circuit and/or the algorithm can act to place the surgicalinstrument into a shut down condition, where the electronics of thesurgical instrument which function to provide communication with asurgical hub stay energized but the surgical instrument is otherwiseprevented from performing certain functionalities, such as closing jaws,firing staples, and/or delivering high frequency electrosurgical energy,for example. By keeping the electronics which function to providecommunication with the surgical hub energized, the surgical hub cancontinue to keep a user of the surgical instrument informed regardingthe operational status of the surgical instrument. Various aspects of asurgical hub are described in more detail in U.S. patent applicationSer. No. 15/940,629, entitled COMPUTER IMPLEMENTED INTERACTIVE SURGICALSYSTEMS, filed on Mar. 29, 2018, the disclosure of which is herebyincorporated by reference in its entirety.

In order to manage the temperatures of the components and/or sub-systemsof the surgical instrument and the continued operation of the surgicalinstrument in heavy use conditions, in various instances, the priorityof operation can be based on the importance level of the component,subsystem and/or task to be performed. Therefore, in certaincircumstances the surgical instrument can be controlled such that thehighest heat generator can go unregulated or only be regulated after acritical task is accomplished.

In some instances, when a component and/or subsystem of the surgicalinstrument is being regulated, a control circuit of the surgicalinstrument, such as a main processor in a handle assembly of thesurgical instrument, for example, can communicate with the surgical hubin order to receive more information on how best to proceed. In someinstances, the situational awareness functionality of the surgical hubcan operate to inform the control circuit of the surgical instrumentthat the surgical instrument is in the middle of a critical task, andthe control circuit and/or an algorithm can then control the surgicalinstrument to either ignore the heat warning or reprioritize theimportance of the component and/or sub-system that was being regulated.Various aspects of situational awareness functionality are described,for example, in U.S. patent application Ser. No. 15/940,654, entitledSURGICAL HUB SITUATIONAL AWARENESS, filed on Mar. 29, 2018, thedisclosure of which is herein incorporated by reference in its entirety.

In some instances, the surgical instrument can be controlled toproportionally limit motor power use based on the sensed/measuredtemperatures or on estimated temperatures. For example, as predeterminedtemperature thresholds are exceeded and/or the rate of temperature riseexceeds a predetermined threshold and/or a modeled heat build-up isapproaching a predetermined threshold, the surgical instrument can becontrolled to reduce the level of power made available to the motor as afirst priority, then reduce the power available for the energy modality(e.g., electrosurgical energy, ultrasonic energy), if any.

FIG. 660 illustrates a method 223600 for determining heat flux fromsensed/measured temperatures over time to predict an occurrence of apredefined temperature threshold being exceeded. At step 223602, thetemperatures of the components and/or sub-systems positioned within thehandle assembly and/or the shaft of the surgical instrument aresensed/measured by a temperature sensing device. At step 223604, theenergy delivered to each motor and to the power circuitry of thesurgical instrument is measured over time by an energy measuring device.At step 223606, the accumulated heat built-up inside the surgicalinstrument is estimated based on the information determined at steps223602 and 223604. At step 223608, the rate of the temperature risewithin the surgical instrument is determined by a control circuit and/oralgorithm of the surgical instrument. Based on the determined rate ofthe temperature rise at step 223608, the time at which the predefinedtemperature threshold will be exceeded can be determined at step 223610by the control circuit and/or an algorithm of the surgical instrument.In some instances, the method 223600 further comprises a step 223612,wherein the rate of temperature rise determined at step 223608 can becompared to a rate of temperature rise predicted by a modeled heatbuild-up to establish a higher level of confidence of the accuracy ofthe determined rate of temperature rise. This comparison can beperformed by the control circuit of the surgical instrument.

FIG. 661 illustrates a graph 223700 which shows a relationship between asensed temperature 223702, an approximated temperature 223704, and anenergy usage 223706 of the surgical instrument. The time t is shownalong a first horizontal axis 223708 and along a third horizontal axis223712. A second horizontal axis 223710 also represents time t. A firstvertical axis 223714 is associated with the approximated temperature223704, a second vertical axis 223716 is associated with the sensedtemperature 223702, and a third vertical axis 223718 is associated withthe energy usage 223706. In various instances, the sensed temperature223702 is a temperature sensed within a handle assembly of the surgicalinstrument, the approximated temperature is a temperature which isestimated by a heat build-up model, and the energy usage 223706represents the total of all energy consumed by the surgical instrumentduring its use in a surgical procedure.

As shown in FIG. 661 , when the surgical instrument is first energized,the level of energy 223706 used by the surgical instrument is very low.The small increase in the sensed temperature 223702 can be attributed tothe electrical circuits within the surgical instrument being energized.From time t₁ to time t₂, when an end effector of the surgical instrumentis being articulated, the energy usage 223706 increases and the sensedtemperature 223702 increases. The approximated temperature 223704 isshown increasing at time t₂. As the articulation is paused between timet₂ and time t₃, the energy usage 223706 stays the same, the sensedtemperature 223702 continues to increase, and the approximatedtemperature 223704 stays the same. From time t₃ to time t₄, when the endeffector is further articulated, the energy usage 223706 increases andthe sensed temperature 223702 increases. The approximated temperature223704 is shown increasing at time t₄.

As the articulation is paused again between time t₄ and time t₅, theenergy usage 223706 stays the same, the sensed temperature 223702continues to increase and the approximated temperature 223704 stays thesame. At time t₅, the energy modality of the surgical instrument, suchas the application of mechanical energy, electrosurgical energy, and/orultrasonic energy, for example, is energized, the energy usage 223706begins to increase significantly, the sensed temperature 223702 reachesthe motor temperature threshold 223720 (which is the same for the sensedtemperature 223702 and the approximated temperature 223704), and theapproximated temperature 223704 increases and passes the motor threshold223720 in the process.

From time t₅ to time t₆, as the energy modality continues to beenergized, the energy usage 223706 increases significantly, the sensedtemperature 223702 increases significantly, exceeding the motorthreshold 223720 at approximately time t₅ and reaching the energythreshold 223722 at time t₆. As a result of the sensed temperature223702 exceeding the motor threshold 223720 at approximately time t₅, acontrol circuit and/or an algorithm of the surgical instrument, such asa main processor in a handle assembly of the surgical instrument, forexample, and/or an algorithm acts to limit the power delivered to themotor (or motors) of the surgical instrument. This limiting remains ineffect until the sensed temperature 223702 falls back below the motorthreshold 223720 at approximately time t₁₀.

At approximately time t₆, the sensed temperature 223702 passes theenergy threshold 223722. As a result of the sensed temperature 223702exceeding the energy threshold 223722 at approximately time t₆, thecontrol circuit and/or the algorithm acts to limit the power deliveredto the energy modality of the surgical instrument. This limiting remainsin effect until the sensed temperature 223702 falls back below theenergy threshold 223722 at approximately time t₇. Once the limiting ofthe power delivered to the energy modality 223702 is halted at time t₇,the sensed temperature 223702 begins to decrease. From time t₈ to timet₉, although the sensed temperature 223702 is still above the motorthreshold 223720, the control circuit and/or the algorithm may allow theend effector to be articulated once again because the sensed temperature223702 is decreasing.

According to various aspects, the motor threshold 223720 and the energythreshold 223722 can be altered/adjusted by the control circuit and/oran algorithm to compensate for differences in air density, altitudeand/or atmospheric pressure as described above.

The devices, systems, and methods disclosed in the Subject Applicationcan be used with the devices, systems, and methods disclosed in U.S.patent application Ser. No. 13/832,786, now U.S. Pat. No. 9,398,905,entitled CIRCULAR NEEDLE APPLIER WITH OFFSET NEEDLE AND CARRIER TRACKS;U.S. patent application Ser. No. 14/721,244, now U.S. Pat. No.10,022,120, entitled SURGICAL NEEDLE WITH RECESSED FEATURES; and U.S.patent application Ser. No. 14/740,724, now U.S. Pat. No. 9,888,914,entitled SUTURING INSTRUMENT WITH MOTORIZED NEEDLE DRIVE, which areincorporated by reference in their entireties herein.

The embodiments disclosed herein are configured for use with surgicalsuturing instruments and systems such as those disclosed in U.S. patentapplication Ser. No. 13/832,786, now U.S. Pat. No. 9,398,905, entitledCIRCULAR NEEDLE APPLIER WITH OFFSET NEEDLE AND CARRIER TRACKS; U.S.patent application Ser. No. 14/721,244, now U.S. Patent ApplicationPublication No. 2016/0345958, entitled SURGICAL NEEDLE WITH RECESSEDFEATURES; and U.S. patent application Ser. No. 14/740,724, now U.S.Patent Application Publication No. 2016/0367243, entitled SUTURINGINSTRUMENT WITH MOTORIZED NEEDLE DRIVE, which are incorporated byreference in their entireties herein. The embodiments discussed hereinare also usable with the instruments, systems, and methods disclosed inU.S. patent application Ser. No. 15/908,021, entitled SURGICALINSTRUMENT WITH REMOTE RELEASE, filed on Feb. 28, 2018, U.S. patentapplication Ser. No. 15/908,012, entitled SURGICAL INSTRUMENT HAVINGDUAL ROTATABLE MEMBERS TO EFFECT DIFFERENT TYPES OF END EFFECTORMOVEMENT, filed on Feb. 28, 2018, U.S. patent application Ser. No.15/908,040, entitled SURGICAL INSTRUMENT WITH ROTARY DRIVE SELECTIVELYACTUATING MULTIPLE END EFFECTOR FUNCTIONS, filed on Feb. 28, 2018, U.S.patent application Ser. No. 15/908,057, entitled SURGICAL INSTRUMENTWITH ROTARY DRIVE SELECTIVELY ACTUATING MULTIPLE END EFFECTOR FUNCTIONS,filed on Feb. 28, 2018, U.S. patent application Ser. No. 15/908,058,entitled SURGICAL INSTRUMENT WITH MODULAR POWER SOURCES, filed on Feb.28, 2018, and U.S. patent application Ser. No. 15/908,143, entitledSURGICAL INSTRUMENT WITH SENSOR AND/OR CONTROL SYSTEMS, filed on Feb.28, 2018, which are incorporated in their entireties herein. Theembodiments discussed herein are also usable with the instruments,systems, and methods disclosed in U.S. Provisional Patent ApplicationSer. No. 62/659,900, entitled METHOD OF HUB COMMUNICATION, filed on Apr.19, 2018, U.S. Provisional Patent Application Ser. No. 62/611,341,entitled INTERACTIVE SURGICAL PLATFORM, filed on Dec. 28, 2017, U.S.Provisional Patent Application Ser. No. 62/611,340, entitled CLOUD-BASEDMEDICAL ANALYTICS, filed on Dec. 28, 2017, and U.S. Provisional PatentApplication Ser. No. 62/611,339, entitled ROBOT ASSISTED SURGICALPLATFORM, filed on Dec. 28, 2017, which are incorporated by reference intheir entireties herein. Generally, these surgical suturing instrumentscomprise, among other things, a shaft, an end effector attached to theshaft, and drive systems positioned within the shaft to transfer motionfrom a source motion to the end effector. The motion source can comprisea manually driven actuator, an electric motor, and/or a robotic surgicalsystem. The end effector comprises a body portion, a needle trackdefined within the body portion, and a needle driver configured to drivea needle through a rotational firing stroke. The needle is configured tobe guided through its rotational firing stroke within the body portionby the needle track. In various instances, the needle driver is similarto that of a ratchet system. In at least one instance, the needle driveris configured to drive the needle through a first half of the rotationalfiring stroke which places the needle in a hand-off position—a positionwhere a tissue-puncturing end of the needle has passed through thetarget tissue and reentered the body portion of the end effector. Atsuch point, the needle driver can be returned to its original positionto pick up the tissue-puncturing end of the needle and drive the needlethrough a second half of its rotational firing stroke. Once the needledriver pulls the needle through the second half of its rotational firingstroke, the needle driver is then returned to its original unfiredposition to grab the needle for another rotational firing stroke. Thedrive systems can be driven by one or more motors and/or manual driveactuation systems. The needle comprises suturing material, such asthread, for example, attached thereto. The suturing material isconfigured to be pulled through tissue as the needle is advanced throughits rotational firing stroke to seal the tissue and/or attached thetissue to another structure, for example.

FIGS. 662-666 depict a surgical suturing instrument 94000 configured tosuture the tissue of a patient. The surgical suturing instrument 94000comprises a handle 94100, a shaft 94200 extending distally from thehandle 94100, and an end effector 94300 attached to the shaft 94200 byway of an articulation joint 94210. The handle 94100 comprises a firingtrigger 94110 configured to actuate a firing drive of the surgicalsuturing instrument 94000, a first rotational actuator 94120 configuredto articulate the end effector 94300 about an articulation axis AAdefined by the articulation joint 94210, and a second rotationalactuator 94130 configured to rotate the end effector 94300 about alongitudinal axis LA defined by the end effector 94300. The surgicalsuturing instrument 94000 further comprises a flush port 94140. Examplesof surgical suturing devices, systems, and methods are disclosed in U.S.patent application Ser. No. 13/832,786, now U.S. Pat. No. 9,398,905,entitled CIRCULAR NEEDLE APPLIER WITH OFFSET NEEDLE AND CARRIER TRACKS;U.S. patent application Ser. No. 14/721,244, now U.S. Patent ApplicationPublication No. 2016/0345958, entitled SURGICAL NEEDLE WITH RECESSEDFEATURES; and U.S. patent application Ser. No. 14/740,724, now U.S.Patent Application Publication No. 2016/0367243, entitled SUTURINGINSTRUMENT WITH MOTORIZED NEEDLE DRIVE, which are incorporated byreference in their entireties herein.

FIGS. 667-669 depict a needle sensing system 91000 configured to be usedwith a surgical suturing instrument system. The needle sensing system91000 comprises a resistive sensing circuit configured to allow acontrol program of a control interface to determine the position of aneedle during its firing stroke by monitoring the resistance of theresistive sensing circuit. The needle sensing system 91000 comprises aneedle sensing circuit 91100 and a needle 91200. The needle sensingcircuit 91100 comprises a supply portion, or leg, 91110 terminating at afirst terminal 91112 and comprising a first resistance R1. The needlesensing circuit 91100 further comprises a return portion 91120comprising a first return leg 91130 terminating at a first returnterminal 91132 and a second return leg 91140 terminating a second returnterminal 91142. The first return leg 91130 and the second return leg91140 are wired in parallel with respect to each other. The first returnleg 91130 comprises a second resistance R2 and the second return leg91140 comprises a third resistance R3. Discussed in greater detailbelow, the needle 91210 is configured to act as a switch for the needlesensing circuit 91100 by contacting the terminals 91112, 91132, and91142 during its firing stroke as the needle 91200 moves in a rotationaldirection to suture tissue. The resistance of such a circuit can bemonitored by a processor to determine the location of the needle 91200during its firing stroke.

The needle 91200 comprises a tip 91213, a butt end 91211, and an arcuateshaft 91212 extending between the tip 91213 and the butt end 91211. Theneedle 91200 further comprises suturing material 91220 attached to thebutt end 91211 of the needle 91200. The tip 91213 comprises a bevel, orpoint, 91215 configured to pierce tissue during a firing stroke of theneedle 91200. As the needle 91200 moves through its firing stroke, it isconfigured to move into and out of contact with the terminals 91112,91132, and 91142. In its starting, or home, position (FIG. 667 ), theneedle 91200 is in contact with all three terminals 91112, 91132, and91142. The total resistance of the circuit 91100 in this configurationcan be detected by the control system of the suturing instrument toidentify that the needle 91200 is in its starting position. The totalresistance of the circuit 91100 in this configuration is shown in thecircuit diagram 91000′ of FIG. 667 and can be referred to as thestarting position resistance. Once the needle 91200 is advanced out ofits starting position and the butt end 91211 of the needle 91200 movesout of contact with the terminal 91112, the needle 91200 has beenpartially fired and is now only in contact with two terminals 91132,91142 (FIG. 668 ). The total resistance of the circuit 91100 in thisconfiguration can be detected by the control system to identify that theneedle 91200 is in a first partially-fired position. The totalresistance of the circuit 91100 in this configuration is shown in thecircuit diagram 91000′ of FIG. 668 and can be referred to as the firstpartially-fired position resistance. Once the needle 91200 is advancedout of contact with the second terminal 91132 and back into contact withthe first terminal 91112, the circuit 91100 now comprises a third totalresistance that is different from the starting position resistance andthe first-partially fired position resistance. This can be referred toas the second partially-fired position resistance (FIG. 669 ). Becausethe second partially-fired position resistance is different than thestarting position resistance and the first partially-fired positionresistance, the second partially-fired position resistance can bedetected to determine that the needle 91200 has moved into the secondpartially-fired position.

The system 91100 permits the needle location to be detected directly.Monitoring the needle location over a period of time can provide meansfor determining the rate of advancement of the needle and/or changes inrate of advancement of the needle during its firing stroke. In variousinstances, if the needle is sensed to be moving at a rate slower thanpreferred, for example, the instrument can automatically adjust a powercontrol program of the motor which is advancing the needle through itsfiring stroke to speed up the needle. Similarly, if the needle is sensedto be moving at a rate faster than preferred, for example, theinstrument can automatically adjust the power control program of themotor which is advancing the needle through its firing stroke to slowdown the needle. This arrangement allows the control program to adaptthe rate and/or sequence at which the needle is fired during a procedureand/or during each firing stroke of the needle to better accommodatevariable conditions such as, for example, variable tissue thicknessesduring suturing.

FIG. 670 illustrates a logic flow diagram of a process 93800 depicting acontrol program for controlling a surgical suturing instrument. Theprocess 93800 comprises monitoring 93801 a position sensing circuitoutput. For example, the output resistance of the system 91110 can bemonitored throughout the operation of a surgical suturing instrument.The process 93800 further includes determining 93803 if the controlmotions applied to the needle need to be adjusted based on the positionsensing circuit output. A processor, for example, can monitor theposition sensing circuit output over a period of time and calculate thespeed of the needle during its firing stroke. If the speed is too fastor too slow for the present tissue thickness, for example, the controlprogram can adjust 93807 the control motions applied to the needle tochange the speed of the needle firing stroke. If the speed of the needleis consistent with a predetermined speed profile for the present tissuethickness, the control program can continue 93805 normal operation ofthe instrument. Other position sensing systems disclosed herein can beused with this process.

FIG. 671 depicts a needle sensing system 91300 configured to allow acontrol system of a suturing instrument to monitor the motions of theneedle within the end effector against the anticipated, or expected,motions of the needle. In various instances, backlash in a motor-drivenneedle drive system, for example, could cause the drive system toproduce a shorter needle stroke than expected for a given amount ofmotor rotations. The needle sensing system 91300 comprises an endeffector 91310, a needle track 91312 defined within the end effector91310, and a needle 91320. Similar to the above, the needle 91320 isconfigured to be actuated by a needle driver to move the needle 91320through a circular firing stroke. The needle 91320 is guided by theneedle track 91312 as the needle 91320 is actuated by the needle driver.The needle sensing system 91300 comprises a plurality of sensors 91340designated as S1, S2, S3, and S4 which, as discussed below, areconfigured to track the motion of the needle 91320. The sensors 91340may be any suitable position-detecting sensor such that, as the needle91320 engages, or trips, a sensor 91340, that sensor sends a voltagesignal to the control system that the sensor 91340 has detected that theneedle 91320 indicating the position of the needle 91320. The needle91320 comprises a tip 91322 that is configured to initially trip thesensors 91340 as the tip 91322 approaches and contacts, or otherwisetrips, the sensors 91340. The end effector 91310 further comprises atissue opening 91314 defined therein. In use, the end effector 91310 ispressed against the patient tissue such that the tissue enters theopening 91314. At such point, the tip 91322 can pierce tissue in theopening 91314 and then re-enter the needle track 91312 on the other sideof the end effector 91310. The needle 91320 is dimensioned to have alarger length than the distance of the opening 91314 so that the needle91320 can be guided by the needle track 91312 back into the needle track91312 before a butt end of the needle exits the end effector 91310 intothe opening 91314.

FIG. 672 is a graph 91350 depicting a portion of a needle firing strokeusing the needle sensing system 91300 of FIG. 671 . As can be seen inthe graph 91350 illustrated in FIG. 672 , there is an overlap ofdetection for each neighboring sensor. During a needle firing stroke,each sensor is configured to detect the tip 91322 of the needle 91320before the previous sensor no longer detects the needle 91320. Inanother embodiment, more than two sensors are configured to sense theneedle during the needle firing stroke.

The sensors 91340 can be used in combination with a control program toensure that a motor driving the needle 91320 through its firing strokeis driving the needle 91320 the expected amount. For example, a certainamount of rotation from the needle drive motor should produce acorresponding travel length of the needle 91320. Monitoring the positionof the needle 91320 in the end effector 91310 along with rotationalmotion of the motor can provide a way to make sure that the motor isproducing the anticipated drive motions of the needle. An example of aneedle stroke where the rotational motion of the motor and the actuallength of needle travel are monitored is depicted in the graph 91360illustrated in FIG. 673 . If the motion of the needle is not asanticipated, the control system can adjust the power delivered to themotor to account for these differences and assure that the needle isbeing driven all the way around its firing path during a firing stroke.For example, if the motor takes more rotations than expected to causethe needle to travel a certain distance, the control system can increasethe number of rotations for the needle to complete the firing stroke.Such instances could be due to backlash in the drive system, forexample.

If the actual motions sensed by a needle position sensing system are notas expected, the control program can place the system in a limp mode,for example, to prevent premature failure of components.

The needle sensing system 91300 can also monitor the current drawn bythe needle drive motor while monitoring the input from the sensors91340. In such an embodiment, a control program can the reverseactuation of the needle 91320 in the event that a substantial increasein current is detected in the motor and the subsequent sensor 91340 hasnot been tripped—possibly indicating that the needle is jammed. In thesame and/or another embodiment, an encoder can be used to measure thenumber of rotations being provided by the motor. A control program cancompare the number of rotations being provided by the motor to the inputfrom the sensors 91340. In an instance where the sensors 91340 are notbeing tripped as expected by a given amount of rotation from the motor,the control program can interrogate the motor current to assess why theneedle is not traveling the expected distance. If the motor current issubstantially high, this could indicate a jam, as discussed above. Ifthe motor current is substantially low, this could indicate that theneedle and the needle driver are no longer coupled, for example, andthat the needle driver is freely moving without driving the needle. Inan alternative embodiment, motor torque can be sensed instead of motorcurrent. An example of current monitoring can be seen in the graph 91370illustrated in FIG. 674 .

FIGS. 675-677 depict a surgical suturing instrument 91500 comprising ashaft 91510, an end effector 91530, and a needle drive system 91550. Thesurgical suturing instrument 91500 is designed to provide a suturingbite width that is larger than the diameter of the shaft 91510 by usingan expandable/collapsible needle guide element. Various suturing devicesare limited to a bite width that is constrained by the diameter of theirshafts. The surgical suturing instrument 91500 comprises a movableneedle guide 91560 rotatably mounted to a body 91540 of the end effector91530 configured to permit the use of a needle 91570, which alsocomprises a length that exceeds the width of the shaft diameter. Toactuate the movable needle guide 91560, a linear actuator 91512connected to a proximal end 91562 of the movable needle guide 91560 isconfigured to be pushed and pulled to pivot the movable needle guide91560 about its pivot point 91562. FIG. 675 illustrates the movableneedle guide 91560 in an expanded configuration where the surgicalsuturing instrument 91500 is ready to be fired. To pivot the movableneedle guide 91560 into its closed configuration (FIG. 676 ), the linearactuator 91512 is pulled proximally. When the movable needle guide 91560is in its closed configuration, the surgical suturing instrument 91500is in a configuration sufficient to be passed through a trocar.

The needle drive system 91550 comprises a linear actuator 91520, aproximal needle feed wheel 91552 configured to be rotated about itspivot 91552 by way of the linear actuator 91520 and rotatably mountedwithin the body 91540 of the end effector 91530, and a distal needlefeed wheel 91554 configured to be rotated about its pivot 91555 by aconnecting link 91556 by way of the proximal needle feed wheel 91552 androtatably mounted within the body 91540 of the end effector 91530. Thefeed wheels 91552, 91554 are configured to be rotated together to movethe flexible needle 91570 through the body 91540 of the end effector91530 and out of the body 91540 of the end effector 91530 against themovable needle guide 91560. The movable needle guide 91560 comprises acurved tip 91563 configured to guide the flexible needle 91570 back intothe body 91540 of the end effector 91530 so that the distal needle feedwheel 91554 can begin guiding the flexible needle 91570 back toward theproximal needle feed wheel 91552. The feed wheels 91552, 91554 areconnected by a coupler bar such that they rotate at the same time.

In various instances, the needle 91570 may need to be repaired orreplaced. To remove the needle 91570 from the end effector 91530, themovable needle guide 91560 may be pivoted outwardly to provide access tothe needle 91570 (FIG. 677 ).

The needle 91570 comprises an arc length A. The distance between thepivots 91553, 91555 of the feed wheels 91552, 91554 is labeled length B.The arc length A of the needle 91570 must be greater than the length Bin order to be able to guide the flexible needle 91570 back into the endeffector body 91540 with the proximal needle feed wheel 91553. Such anarrangement allows a capture, or bite, width 91580 of the surgicalsuturing instrument 91500 to be larger than the diameter of the shaft91510. In certain instances, a portion of the end effector containingthe needle drive system 91550 can be articulated relative to the endeffector body 91540 so that the capture width, or opening, 91580 canhinge outwardly and face tissue distally with respect to the instrument91500. This arrangement can prevent a user from having to preform thesuturing procedure with respect to the side of the instrument 91500.Such a feature may utilize a hinge mechanism with snap features torigidly hold the end effector body 91540 in a firing position as opposedto a position suitable for insertion through a trocar.

As outlined above, a portion of the end effector 91530 is movable toincrease or decrease the width of the end effector 91530. Decreasing thewidth of the end effector 91530 allows the end effector 91530 to beinserted through a narrow trocar passageway. Increasing the width of theend effector 91530 after it has been passed through the trocar allowsthe end effector 91530 to make larger suture loops in the patienttissue, for example. In various instances, the end effector 91530 and/orthe needle 91570 can be flexible so that they can be compressed as theyare inserted through the trocar and then re-expand once they have passedthrough the trocar. Such an arrangement, as described above, allows alarger end effector to be used.

FIG. 678 depicts a collapsible suturing device 92300 comprising a shaft92310 and an end effector 92320 configured to be articulated relative tothe shaft 92310. The device 92300 comprises a tissue bite region havinga larger width than its shaft diameter. The end effector 92320 ishingedly coupled to the shaft 92310. The collapsible suturing device92300 comprises a separate actuation member to rotate the end effector92320 relative to the shaft 92310. In other embodiments, the endeffector 92320 can be spring biased into a straight configuration wherea user may apply torque to a distal end of the end effector 92320 bypressing the end effector 92320 against tissue to rotate the endeffector 92320 relative to the shaft 92310. In either event, such anarrangement provides the device 92300 with a distal-facing tissue biteregion 92321 which can permit a user to more accurately and/or easilytarget tissue to be sutured.

The tissue bite region 92321 is larger than the diameter of the shaft92310. During use, a user would insert the collapsible suturing device92300 into a trocar while the device 92300 is in its straightconfiguration. After the device 92300 is inserted through the trocar,the user may actively rotate the end effector 92320 with an actuator toorient the end effector 92320 properly to prepare to suture the tissue.Once the end effector 92320 is oriented to face the tissue to besutured, a movable needle guide may be actuated outwardly to prepare toadvance the needle through a needle firing stroke. In thisconfiguration, the end effector 92320 can then be pressed against thetissue to be sutured and the needle can be advanced through a needlefiring stroke. Once suturing is complete, the needle guide can becollapsed and the end effector 92320 can be rotated back into itsstraight configuration to be removed from the patient through thetrocar. The needle may be taken out of the end effector 92320 before orafter the end effector 92320 has passed back out of the patient throughthe trocar.

FIG. 679 depicts a collapsible suturing device 92400 comprising a shaft92410 and an end effector 92420 attached to the distal end of the shaft92410. The device 92400 comprises a tissue bite region having a largerwidth than its shaft diameter. The end effector 92420 further comprisesa needle driving system 92430 configured to drive a flexible needlethrough a needle firing stroke against a movable needle guide 92440. Theneedle driving system 92430 comprises a proximal feed wheel 92431, adistal feed wheel 92433, and an intermediate feed wheel 92435 configuredto feed the flexible needle through the end effector 92420. Theintermediate feed wheel 92435 permits the use of a longer flexibleneedle than arrangements without an intermediate feed wheel. Embodimentsare envisioned where the intermediate feed wheel is actively connectedthe needle driving system. In other instances, the intermediate feedwheel is an idler component and rotates freely. In at least oneembodiment, the needle comprises a width that is larger than the widthof the shaft with which is used.

FIGS. 680-682 depict a surgical suturing end effector 91600 configuredto provide a suturing device with a variable needle stroke. In variousinstances, the needle stroke of the end effector 91600 can be differentevery time the end effector 91600 is fired. The end effector 91600 alsocan provide a suturing bite width that is wider than the diameter of itsshaft. The surgical suturing end effector 91600 comprises a body portion91610 having a tissue-engaging opening 91612, a needle track 91620defined within the body portion 91610, and a needle 91630 configured tobe guided through a firing stroke by the needle track 91620. FIG. 680illustrates the needle 91630 in its parked position where the endeffector 91600 can be passed through a trocar. Once the end effector91600 is passed through a trocar, the needle 91630 is advanced linearlyfrom a park track portion 91621 of the needle track 91620—by way of itsproximal end 91633—to a ready-to-fire position (FIG. 681 ). As can beseen in FIG. 681 , the needle 91630 extends outwardly beyond the body91610 of the end effector 91600 when the needle 91630 is in itsready-to-fire position. Such an arrangement allows for an instrument tohave a tissue bite width that is larger than the diameter of theinstrument's shaft. The needle 91630 comprises a canoe-like shape butcan comprise any suitable shape to achieve this.

When a clinician wants to complete a suture stroke, discussed in greaterdetail below, the needle 91630 is moved to the position shown in FIG.682 referred to as the hand-off position. To get to this position, theproximal end 91633 of the needle 91630 is rotated and advanced linearlywithin a first track portion 91622 of the track 91620 until the proximalend 91633 of the needle 91630 reaches a distal end 91623 of the firsttrack portion 91622 and a tip portion 91634 of the needle 91630 engagesa distal end 91625 of a second track portion 91624 of the track 91620.This engagement allows a needle driver that rotates and linearlyadvances the needle 91630 within the track 91620 to move along the track91620 to the distal end 91625 of the second track portion 91624 to grabthe tip portion 91634 and pull the needle 91630 through the end effector91600 by pulling the needle 91630 proximally and rotating the needle91630 to prepare for a second firing stroke of the needle 91630. At acertain point after the needle 91630 attains the hand-off position (FIG.682 ), the needle driver can re-connect, or re-engage, with the proximalend 91633 of the needle 91630 to begin a second firing stroke to returnthe needle 91630 to its ready-to-fire position illustrated in FIG. 681 .The firing stroke of the needle 91630, having a canoe-like shape, canresemble a box-shaped, or diamond-shaped, path.

FIG. 683 is a stress-strain diagram 91700 of the loads experienced by aneedle during a firing stroke. A control system of a surgical suturinginstrument can monitor input from a strain gauge and adjust theoperation of the surgical suturing instrument based on the monitoredstrain and/or display the strain to a user during use. The surgicalsuturing instrument can alert a user when the needle has reached 75%91701 of its yield strength during a suturing procedure. The surgicalinstrument can provide the clinician with an option to adjust theadvancement speed of the needle to help prevent further spikes of thestrain and/or stress within the needle. If the needle reaches 100% 91703of its yield strength, overstress may be reported to the user and thecontrol system will report the overstress to the system disclosed inU.S. patent application Ser. No. 15/908,021, entitled SURGICALINSTRUMENT WITH REMOTE RELEASE, filed on Feb. 28, 2018, U.S. patentapplication Ser. No. 15/908,012, entitled SURGICAL INSTRUMENT HAVINGDUAL ROTATABLE MEMBERS TO EFFECT DIFFERENT TYPES OF END EFFECTORMOVEMENT, filed on Feb. 28, 2018, U.S. patent application Ser. No.15/908,040, entitled SURGICAL INSTRUMENT WITH ROTARY DRIVE SELECTIVELYACTUATING MULTIPLE END EFFECTOR FUNCTIONS, filed on Feb. 28, 2018, U.S.patent application Ser. No. 15/908,057, entitled SURGICAL INSTRUMENTWITH ROTARY DRIVE SELECTIVELY ACTUATING MULTIPLE END EFFECTOR FUNCTIONS,filed on Feb. 28, 2018, U.S. patent application Ser. No. 15/908,058,entitled SURGICAL INSTRUMENT WITH MODULAR POWER SOURCES, filed on Feb.28, 2018, and U.S. patent application Ser. No. 15/908,143, entitledSURGICAL INSTRUMENT WITH SENSOR AND/OR CONTROL SYSTEMS, filed on Feb.28, 2018, which are incorporated in their entireties herein. If theneedle reaches 125% 91705 of its yield strength, the user is alerted ofthis threshold and the control program automatically slows the speed andmay disable the instrument from actuating the needle any further, and/orrequest action to be taken before any further use of the surgicalsuturing instrument.

FIGS. 684 and 685 depict a method for detecting the proper and/orimproper attachment of a modular shaft to a surgical instrument handleand/or surgical robot, for example. FIG. 684 depicts an attachmentassembly 91800 attachable to an attachment interface 91810—which can bea surgical instrument handle and/or robotic attachment, or control,interface. Monitoring the torque of a drive system coupled at theattachment interface 91810 can provide a way to determine if theattachment interface 91810 and the modular attachment 91820 have beensuccessfully attached or not.

Referring to the graph 91830, the solid plot line represents a scenariowhere an attempt at attaching the modular attachment 91820 to theattachment interface 91810 was made, and the modular attachment 91820and the attachment 91830 slipped out of engagement thereby causing areduction in torque of the actuation drive system below a minimum torquethreshold representing an unsuccessful attachment and engagement ofdrive systems. The torque of a failed attempt is noticeably differentthan the torque of a successful attempt which is also illustrated in thegraph 91830. In another embodiment, the current of the motor that drivesthe drive system can be directly monitored. Referring now to the graph91830′, the surgical instrument is equipped with a control system thatshuts off the motor in this scenario (1) when the torque sensed dropsbelow the minimum threshold torque. The control system can also alert auser that the motor has been stopped because attachment was notsuccessful. Referring again to the graph 91830, a second scenario isillustrated by a dashed plot line where attachment is made, however, thetorque sensed increases above a maximum torque threshold. This couldindicate a jam between the attachment interface 91810 and the modularattachment 91820. Referring again to the graph 91830′, the surgicalinstrument is equipped with a control system that limits the torquedelivered by the drive system when the torque sensed increases above themaximum threshold torque, as illustrated in the dashed plot linerepresenting the second scenario (2). Such a limiting of torque deliverycan prevent the breaking of components in the modular attachment 91820and/or the attachment interface 91810.

In various embodiments, strain gauges can be fitted to frame elements ofthe modular attachments to monitor force applied to tissue with theframe elements themselves. For example, a strain gauge can be fitted toan outer shaft element to monitor the force experienced by the shaft asthe modular attachment is pushed against tissue and/or as the modularattachment pulls tissue. This information can be communicated to theuser of the instrument so that the user is aware of the pressure beingapplied to the tissue by the grounded elements of the modular attachmentdue to manipulation and movement of the modular attachment within thesurgical site.

FIGS. 686 and 687 depict a surgical instrument system 91910 that isconfigured to monitor unexpected electrical potential applied to asurgical instrument during an operation that involves using a mono-polarbridge instrument. FIG. 686 depicts a system 91910 comprising a grasper91912 and a mono-polar bridge instrument 91914 being used in the samesurgical site. In one scenario, now referring to the graph 91930 in FIG.687 , the voltage potential of the grasper 91912 can be monitoredthroughout the use of the system 91910 during an operation. Stage (1) ofthe graph 91920 represents the beginning of articulation of the grasper91912 using motorized articulation. Stage (2) represents a spike indetected voltage potential of the grasper 91912. Such a spike in voltagepotential can be conducted to the grasper 91912 by way of the mono-polarbridge instrument 91914. At this stage, the system 91910 canautomatically reverse the motor direction Stage (3) of articulation tomove the grasper 91912 away from the mono-polar bridge instrument 91914until the unexpected voltage spike subsides Stage (4). The controlprogram of the system 91910 can then instruct the articulation motor toautomatically reverse the articulation a predetermined amount passed thepoint when the system 91910 no longer detects the voltage spike toensure that this voltage spike will not occur again due to minorinadvertent movement of either the grasper 91912 and/or the mono-polarbridge instrument 91914.

The surgical instrument can also alert the user when an unexpectedvoltage potential is detected and await further action by a user of theinstrument. If the user is using the instrument that experiences thevoltage spike as a mono-polar bridge instrument then the user couldinform the instrument of this to continue actuation of the instrument.The instrument can also include an electrical circuit, or ground path,to interrupt the flow of electricity beyond a dedicated position whenthe instrument experiences an unexpected voltage potential. In at leastone instance, the ground path can extend within a flex circuit extendingthroughout the shaft.

FIG. 688 illustrates a logic diagram of a process 93900 depicting acontrol program for controlling a surgical instrument. The process 93900comprises sensing 93901 an electrical potential applied to theinstrument. For example, the voltage of an electrical circuit whichincludes the instrument can be monitored. The process 93900 furtherincludes determining 93903 if the sensed electrical potential is above apredetermined threshold based on the sensed electrical potential. Aprocessor, for example, can monitor the voltage and, if a voltage spikeoccurs, the processor can change the operation of the surgicalinstrument. For instance, the process can adjust 93907 the controlmotions of the instrument such as reversing a previous motion, forexample. If the sensed electrical potential is below the predeterminedthreshold, the control program can continue 93905 the normal operationof the instrument.

In various embodiments, surgical suturing instruments can include meansfor detecting the tension of the suture during the suturing procedure.This can be achieved by monitoring the force required to advance aneedle through its firing stroke. Monitoring the force required to pullthe suturing material through tissue can indicate stitch tightnessand/or suture tension. Pulling the suturing material too tight during,for example, tying a knot can cause the suturing material to break. Theinstrument can use the detected forces to communicate stitch tightnessto the user during a suturing procedure and let the user know that thestitch is approaching its failure tightness or, on the other hand, isnot tight enough to create a sufficient stitch. The communicated stitchtightness can be shown to a user during a suturing procedure in aneffort to improve the stitch tightness throughout the procedure.

In various embodiments, a surgical suturing instrument comprises amethod for detecting load within the end effector, or head, of theinstrument, and a control program to monitor this information andautomatically modify, and/or adjust, the operation of the instrument. Inone instance, a needle holder and/or a needle drive can comprise astrain gauge mounted thereon to monitor the force and stress beingexperienced by the needle during its firing stroke. A processor of theinstrument can monitor the strain sensed by the strain gauge bymonitoring the voltage reading that the strain gauge provides and, ifthe force detected is above a predetermined threshold, the processor canslow the needle and/or alert a user of the instrument that the needle isexperiencing a force greater than a certain threshold. Other parameters,such as needle velocity and/or acceleration, for example, can bemonitored and used to modify the operation of the surgical instrument.

Many different forces experienced by a surgical suturing instrument canbe monitored throughout a suturing procedure to improve efficiency ofthe operation. FIG. 689 depicts a surgical suturing instrument 92200comprising a shaft 92210, an end effector 92230, and an articulationjoint 92220 attaching the end effector 92230 to the shaft 92210 andpermitting articulation of the end effector 92230 relative to the shaft92210. The end effector 92230 comprises a frame 92232 and a suturecartridge 92234. The cartridge 92234 comprises a needle 92236 comprisingsuturing material 92238 attached thereto configured to pass throughtissue T.

Various parameters of the instrument 92200 can be monitored during asurgical suturing procedure. The force, or load, experienced by theneedle 92236 can be monitored, the torque load that resists distal headrotation of the end effector 92230 can be monitored, and/or the bendingload of the shaft 92210 that can cause drive systems within the shaft tobind up can be monitored. The monitoring of these parameters isillustrated in the graph 92100 in FIG. 690 . The surgical instrument92200 is configured to limit corresponding motor current if certainthresholds of the parameters are exceeded. The force experienced by theneedle 92236 is represented by the solid plot line in the graph 92100.This force can directly correspond to the current drawn by the motorthat fires the needle 92236. As the load on the needle 92236 increases,the motor that is firing the needle slows down thereby reducing the loadon the needle and reducing current through the motor. If this force, orcurrent, exceeds a certain pre-determined threshold, the power appliedto the needle firing motor can be limited to prevent possible failure ofdrive system components and/or driving a needle through an unintendedtarget. This limiting event is labeled (1) in the reaction graph 92120.The torque load experienced by the end effector 92230 is represented bythe dashed plot in the graph 92100. This torque load can be a result oftrying to rotate the end effector 92230 while the suturing material92238 is still connected to tissue T and the needle 92236. This torqueload can directly correspond to the current of the motor that rotatesthe end effector 92230. If this torque load, or current, exceeds acertain pre-determined threshold, power to the motor that rotates theend effector 92230 can be limited. This limiting event is labeled (2) inthe reaction graph 92120. The bending load experienced by the shaft92210 is represented by the dash-dot plot in the graph 92100 and can besensed by using a strain gauge placed on the shaft 92210, for example.If this bending load exceeds a certain pre-determined threshold, powerto the motor that rotates the end effector 92230 can be limited andreduced. This limiting event is labeled (3) in the reaction graph 92120.

FIG. 691 illustrates a logic diagram of a process 94000 depicting acontrol program for controlling a surgical suturing instrument. Theprocess 94000 comprises monitoring 94001 one or more detectableparameters of the surgical suturing instrument. For example, the forceexperienced by the suturing needle, the torque load experienced by theshaft of the instrument, and/or the torque load experienced by the endeffector of the instrument can be monitored. In fact, any combination ofdetectable parameters can be monitored. The process 94000 furtherincludes determining 94003 if the detected parameters warrant a changein the operation of the instrument. For example, if the shaft isexperiencing a torque load that is greater than a predeterminedthreshold, the control program can adjust 94007 the control motionsapplied to the end effector, such as stopping the actuation of theinstrument, until the torque experienced by the shaft falls below thepredetermined threshold. If all of the detected parameters are withinoperational conditions, the control program can continue 94005 thenormal operation of the instrument.

Another system for detecting and/or monitoring the location of thesuturing needle during its firing stroke can include utilizing one ormore magnets and Hall Effect sensors. In such an embodiment, a permanentmagnet can be placed within and/or on the needle and a Hall Effectsensor can be placed within, or adjacent to, the needle track, forexample. In such an instance, movement of the needle will cause themagnet to move into, within, and/or out of the field created by the HallEffect sensor thereby providing a way to detect the location of theneedle. In the same embodiment, and/or in another embodiment, a magnetcan be placed on one side of the needle track and a corresponding HallEffect sensor can be placed on the other side of the needle track. Insuch an embodiment, the needle itself can interrupt the magnetic fieldbetween the magnet and the Hall Effect sensor as the needle passesbetween the two magnets, thereby providing a way to detect the locationof the needle.

FIGS. 692 and 693 depict a surgical suturing end effector assembly 93100configured to suture the tissue of a patient during a surgical suturingprocedure. The end effector assembly 93100 comprises a shaft 93110 andan end effector 93120 extending distally from the shaft 93110. The endeffector 93120 comprises a first jaw 93130 and a second jaw 93140configured to receive a replaceable suturing cartridge 93141 therein.The suturing cartridge 93141 comprises a needle 93152 and suturematerial 93150 attached thereto configured to be driven through a needlefiring stroke and guided by a needle track 93142 in the suturingcartridge 93141.

The surgical suturing end effector assembly 93100 further comprises aneedle sensing system comprising a magnet 93162 and a Hall Effect sensor93164. The magnet 93162 and Hall Effect sensor 93164 are positionedwithin the suturing cartridge 93141 such that the needle 93152 isconfigured to interrupt the magnetic field between the magnet 93162 andthe Hall Effect sensor 93164. Such an interruption can indicate to acontrol program the position of the needle 93152 relative to thesuturing cartridge 93141 and/or within its firing stroke. The sensor andmagnet may be embedded within the cartridge and/or placed adjacent theneedle track such as, for example, on top of, on bottom of, and/or onthe sides of the needle track.

FIG. 694 depicts a needle sensing system 93200 positioned within asuturing cartridge 93240. The suturing cartridge 93240 comprises aneedle 93252 and a needle track 93242 configured to guide the needle93252 through a needle firing stroke. The needle sensing system 93200comprises a magnet 93264 and a Hall Effect sensor 93262 positioned aboveand below, respectively, the needle track 93242. The Hall Effect sensor93262 and the magnet 93264 are configured to indicate the position ofthe needle to a control circuit as the needle interrupts the magneticfield between the Hall Effect sensor 93262 and the magnet 93264. Such anarrangement can provide a more localized needle position detectionsystem. In at least one embodiment, a suturing cartridge can containmore than one Hall Effect sensor and magnet arranged in this manner toprovide multiple detection locations along the needle track. That said,any suitable sensor arrangement can be used. A control program candetermine the position of the needle based on the sensor reading(s) ofthe Hall Effect sensor(s). A control program of the surgical instrumentcan adjust control motions applied to the surgical suturing instrumentbased on the readings from the Hall Effect sensor(s). For example, ifthe needle is detected to be moving slower than preferred during afiring stroke based on the time it takes for the needle to tripconsecutive sensors, the control program can increase the speed of themotor driving the needle through its firing stroke. Also, for example,the control program can compensate for a lag in the position of theneedle during its stroke. In at least one instance, the electrical motorof the needle firing drive can be left on for a few additional rotationsto reposition the needle in its stroke.

Another system for detecting and/or monitoring the location of thesuturing needle during its firing stroke can include utilizing one ormore proximity sensors near the needle and/or the needle driver. Asdiscussed above, the needle driver is configured to drive the needle outof its needle track and back into the other side of the needle track,release the needle, and return to its original position to grab theneedle on the other side of the track to prepare for a second half of afiring stroke. The proximity sensor(s) can be used to monitor thelocation of the needle and/or the needle driver. In an instance wheremultiple proximity sensors are used, a first proximity sensor can beused near the entry point on the needle track and a second proximitysensor can be used near the exit point on the needle track, for example.

FIG. 695 depicts a needle sensing system 93300 positioned within asuturing cartridge 93340. The suturing cartridge 93340 comprises aneedle 93352 and a needle track 93342 configured to guide the needle93352 through a needle firing stroke. The needle sensing system 93300comprises a plurality of proximity sensors 93362 positioned within theneedle track 93342. In at least one embodiment, the sensors 93362 aremolded into a sidewall 93343 of the needle track 93342. In the sameembodiment and/or another embodiment, the sensors 93362 are molded intoa top, or bottom, surface 93345 of the needle track 93342. Any suitablelocation within the end effector assembly can be used. The sensorinformation can be used to determine the location of the needle 93352which can then be used to modify the operation of the surgicalinstrument if appropriate.

In at least one embodiment, a plurality of proximity sensors can be usedwithin the end effector of a suturing device to determine if a needle ofthe suturing device has been de-tracked or fallen out of its track. Toachieve this, an array of proximity sensors can be provided such thatthe needle contacts at least two sensors at all times during its firingstroke. If a control program determines that only one sensor iscontacted based on the data from the proximity sensors, the controlsystem can then determine that the needle has been de-tracked and modifythe operation of the drive system accordingly.

FIG. 696 depicts a needle sensing system 93400 positioned within asuturing cartridge 93440. The suturing cartridge 93440 comprises aneedle 93452 and a needle track 93442 configured to guide the needle93452 through a needle firing stroke. The needle sensing system 93400comprises a plurality of conductive sensors 93462 positioned within theneedle track 93442. In one embodiment, the sensors 94362 are positionedadjacent a sidewall 93443 of the needle track 93442 such that the needle93452 may progressively contact the sensors 94362 as the needle 93452progresses through a needle firing stroke. In the same embodiment and/oranother embodiment, the sensors 93462 are positioned adjacent a top, orbottom, surface 93445 of the needle track 93442. Any suitable locationwithin the end effector assembly can be used. The sensor information canbe used to determine the location of the needle 93452 which can then beused to modify the operation of the surgical instrument if appropriate.

Another system for detecting and/or monitoring the location of thesuturing needle during its firing stroke can include placing a circuitin communication with the needle track. For example, a conductive supplyleg can be wired in contact with one side of the needle track and aconductive return leg can be wired in contact with the other side of theneedle track. Thus, as the needle passes by the circuit, the needle canact as a circuit switch and complete the circuit to lower the resistancewithin the circuit thereby providing a way to detect and/or monitor thelocation of the needle. Several of these circuits can be placedthroughout the needle track. To aid the needle conductivity between thecircuit contacts, brushes can be used to cradle the needle as the needlepasses the circuit location. A flex circuit can also be used and can beadhered to inner walls of the needle track, for example. The flexcircuit can contain multiple contacts, and/or terminals. In at least oneinstance, the contacts can be molded directly into the walls. In anotherinstance, the contacts of the flex circuit can be folded over an innerwall of the needle track and stuck to the wall with an adhesive, forexample, such that the contacts face the needle path. In yet anotherinstance, both of these mounting options can be employed.

Another system for detecting and/or monitoring the location of thesuturing needle during its firing stroke can include one or moreinductive sensors. Such sensors can detect the needle and/or the needlegrabber, or driver.

Another system for detecting and/or monitoring the location of thesuturing needle during its firing stroke can include using a lightsource and a photodetector which are positioned such that movement ofthe needle interrupts the detection of the light source by thephotodetector. A light source can be positioned within, and/or near, theneedle track, for example, and faced toward the needle path. Thephotodetector can be positioned opposite the light source such thatneedle can pass between the light source and the photodetector therebyinterrupting the detection of light by the photodetector as the needlepasses between the light source and the photodetector. Interruption ofthe light provided by the light source can indicate the needle'spresence or lack thereof. The light source may be an infrared LEDemitter, for example. Infrared light may be preferred due to its abilityto penetrate tissue and organic debris, especially within a suturingsite, which otherwise could produce a false positive reading by thephotodetector. That said, any suitable light emitter could be used.

FIG. 697 depicts a needle sensing system 93500 positioned within asuturing cartridge 93540. The suturing cartridge 93540 comprises aneedle 93552 and a needle track 93542 configured to guide the needle93552 through a needle firing stroke. The needle sensing system 93500comprises a light source 93562 positioned at an entry point 93545 of theneedle track 93542 and a photodetector 93564 positioned at an exit point93543 of the needle track 93542. When the needle 93552 is in its homeposition as illustrated in FIG. 697 , the light source 93562 isconfigured to emit light that spans across the capture opening of thesuturing cartridge 93540 to indicate that the needle 93552 is in itshome position. Once the needle 93552 interrupts the path between thelight source 93562 and the photodetector 93564, a control program candetermine that the needle is not in its home position. The location ofthe needle 93552 can be determined by a control program based on theinterruption of light between the light sources and photodetectors whichcan then be used to modify the operation of the surgical instrument ifappropriate.

FIG. 698 depicts a needle sensing system 93600 positioned within asuturing cartridge 93640. The suturing cartridge 93640 comprises aneedle 93652 and a needle track 93642 configured to guide the needle93652 through a needle firing stroke. The needle sensing system 93600comprises a light source 93662 and a photodetector 93664 positioned atan exit point 93643 of the needle track 93642. The light source 93662 isconfigured to emit light that spans across the needle track cavity ofthe suturing cartridge 96640 to indicate the position of the needle93652. In another embodiment, another photodetector and light source arepositioned at an exit point 93645 of the needle track 93642. In yetanother embodiment, an array of photodetectors and light sources areplaced along the length of the needle track 93642. The location of theneedle 93652 can be determined by a control program based on theinterruption of light between the light source 93662 and thephotodetector 93664.

In at least one embodiment, a surgical suturing needle can comprise ahelical profile to provide helical suturing strokes. Such a needlecomprises a length spanning 360 degrees where a butt end of the needleand a tip of the needle do not reside in the same plane and define avertical distance therebetween. This needle can be actuated through ahelical, or coil shaped, stroke to over-sew a staple line, for example,providing a three dimensional needle stroke. A needle having the helicalshape discussed above provides a three dimensional suturing path.

FIGS. 699 and 700 depict a helical suturing needle assembly 93700 foruse with a surgical suturing instrument. The suturing needle assembly93700 comprises a tip 93704, a proximal end 93706, and a helical bodyportion 93702 extending therebetween. The helical body portion 93702comprises a catch feature 93701 that a needle driver of a surgicalsuturing instrument is configured to catch on a return stroke of thedriver. The tip 93704 and the proximal end 93706 reside in differenthorizontal planes and comprise a vertical distance therebetween;however, the tip 93704 and the proximal end 93706 terminate along acommon axis A (FIG. 700 ). The needle assembly 93700 can be actuatedthrough a helical, or coil shaped, stroke to over-sew a staple line, forexample, providing a three dimensional needle stroke.

In various instances, the needle comprises a circular configuration thatis less than 360 degrees in circumference. In at least one instance, theneedle can be stored in the end effector in an orientation which storesthe needle within the profile of the end effector. Once the end effectoris positioned within the patient, the needle can be rotated out of itsstored position to then perform a firing stroke.

In various embodiments, a surgical suturing instrument can accommodatedifferent needle and suture sizes for different suturing procedures.Such an instrument can comprise a means for detecting the size of theneedle and/or suture loaded into the instrument. This information can becommunicated to the instrument so that the instrument can adjust thecontrol program accordingly. Larger diameter needles may be rotatedangularly at a slower rate than smaller diameter needles. Needles withdifferent lengths may also be used with a single instrument. In suchinstances, a surgical instrument can comprise means for detecting thelength of the needle. This information can be communicated to a surgicalinstrument to modify the needle driver's path, for example. A longerneedle may require a smaller stroke path from the needle driver tosufficiently advance the longer needle through its firing stroke asopposed to a smaller needle which may require a longer stroke path fromthe needle driver to sufficiently advance the shorter needle through itsfiring stroke in the same needle track.

FIG. 701 depicts a logic diagram of a process 94100 depicting a controlprogram for controlling a surgical instrument. The process 94100comprises detecting 94101 the type of suturing cartridge installedwithin the surgical suturing instrument. In various instances, differentsuture cartridges may have different suture lengths, needle lengths,needle diameters, and/or suture materials, for example. The type ofsuture cartridge and/or its characteristics can be communicated to acontrol circuit by an identification chip positioned within thecartridge such that, when a suture cartridge is installed within asurgical instrument, the control circuit can identify what type ofcartridge has been installed and assess the characteristics of thesuture cartridge. In order to accommodate different cartridge types, acontrol circuit may adjust the control motions that will be applied tothe suture cartridge. For example, firing speeds may differ fordifferent sized needles. Another example may include adjusting the rangeof angular needle rotation based on different needle lengths, or sizes.To accommodate such differences, the process 94100 implemented by aprocess, for example, comprises adjusting 94103 a motor control programof the instrument based on what type of suture cartridge is installed.

In at least one embodiment, a suture needle is stored in a suturinginstrument in a folded manner. In at least one such instance, the sutureneedle comprises two portions which are hingedly connected to oneanother at a hinge. After the end effector has been passed through thetrocar, the suture needle can be unfolded and locked into its unfoldedconfiguration. In at least one instance, a one-way snap feature can beused to rigidly hold the suture needle in its unfolded configuration.

In at least one embodiment, a surgical instrument is configured to applya suture to the tissue of a patient which comprises a lockout system.The lockout system comprises a locked configuration and an unlockedconfiguration. The surgical instrument further comprises a controlcircuit and is configured to identify if a cartridge is installed or notinstalled within an end effector of the surgical instrument. The controlcircuit is configured to place the lockout system in the lockedcondition when a cartridge is not installed in the end effector andplace the lockout system in the unlocked condition when a cartridge isinstalled in the end effector. Such a lockout system can include anelectrical sensing circuit of which a cartridge can complete uponinstallation indicating that a cartridge has been installed. In at leastone instance, the actuator comprises an electric motor and the lockoutsystem can prevent power from being supplied to the electric motor. Inat least one instance, the actuator comprises a mechanical trigger, andthe lockout system blocks the mechanical trigger from being pulled toactuate the suture needle. When the lockout system is in the lockedconfiguration, the lockout system prevents an actuator from beingactuated. When the lockout system is in the unlocked configuration, thelockout system permits the actuator to deploy the suture positionedwithin the cartridge. In one embodiment, the control circuit provideshaptic feedback to a user of the surgical instrument when the electricalsensing circuit places the surgical instrument in the lockedconfiguration. In one embodiment, the control circuit prevents theactuation of an electric motor configured to actuate the actuator whenthe electrical sensing circuit determines that the lockout system is inthe locked configuration. In one embodiment, the lockout system is inthe unlocked configuration when a cartridge is positioned in the endeffector and the cartridge has not been completely expended.

FIGS. 702 and 703 depict a handle assembly 95200 that is operable foruse a surgical suturing instrument. The handle assembly 95200 isconnected to a proximal end of a shaft. The handle assembly 95200includes a motor 95202 and a transmission assembly 95210. The motor95202 is configured to actuate a needle of a surgical suturing endeffector by way of a needle driver, articulate the end effector, androtate the end effector by way of the transmission assembly 95210. Thetransmission assembly 95210 is shifted between three states by a doubleacting solenoid, for example, so as to allow the motor 95202 to be usedto actuate a needle of a surgical suturing end effector, articulate theend effector, and/or rotate the end effector. In at least oneembodiment, the handle assembly 95200 could take the form of a roboticinterface or a housing comprising gears, pulleys, and/orservomechanisms, for example. Such an arrangement could be used with arobotic surgical system.

FIG. 704 depicts a suturing cartridge 93590 comprising a lower body93581, an upper body 93582, and a needle cover 93583. The cartridge93590 further comprises a drive system comprising a needle driver 93586,a rotary input 93594, and a link 93585 connecting the needle driver93586 and the rotary input 93594. The needle driver 93586, rotary input93594, and link 93585 are captured between the lower body 93581 and theupper body 93582. The needle driver 93586, the link 93585, and therotary input 93594 are configured to be actuated to drive a needle 93570through a needle firing stroke by way of a motor-driven system, amanually-driven handheld system, and/or a robotic system, for example.The lower and upper bodies 93581, 93582 are attached to one anotherusing any suitable technique, such as, for example, welds, pins,adhesives, and/or the like to form the cartridge body. The needle 93570comprises a leading end 93571 configured to puncture tissue, a trailingend 93572, and a length of suture 93573 extending from and attached tothe trailing end 93572. The needle 93570 is configured to rotate in acircular path defined by a needle track 93584. The needle track 93584 isdefined in the cartridge body. The needle 93570 is configured to exitone of a first arm 95393A and a second arm 95393B of the cartridge bodyand enter the other of the first arm 95393A and the second arm 95393Bduring a needle firing stroke. Recessed features 93574 are provided toso that the needle driver 93586 can engage and drive the needle 93570through the needle firing stroke in a ratchet-like motion. The needle93570 is positioned between the needle track 93584 and the needle cover93583. The suturing cartridge 93590 further comprises a cage 93587 thatis configured to slide over the cartridge body to attach the needlecover 93583 to the lower body 93581.

A surgical system 128000 is illustrated in FIG. 705 . The surgicalsystem 128000 comprises a handle, a shaft 128020 extending from thehandle, and an end effector 128030 extending from the shaft 128020. Inalternative embodiments, the surgical system 128000 comprises a housingconfigured to be mounted to a robotic surgical system. In at least onesuch embodiment, the shaft 128020 extends from the robotic housing mountinstead of the handle. In either event, the end effector 128030comprises jaws 128040 and 128050 which are closeable to grasp a target,such as the tissue T of a patient and/or a suture needle, for example,as discussed in greater detail below. The jaws 128040 and 128050 arealso openable to dissect the tissue of a patient, for example. In atleast one instance, the jaws 128040 and 128050 are insertable into thepatient tissue to create an otomy therein and then spread to open theotomy, as discussed in greater detail below.

Referring again to FIG. 705 , the jaws 128040 and 128050 are pivotablycoupled to the shaft 128020 about a pivot joint 128060. The pivot joint128060 defines a fixed axis of rotation, although any suitablearrangement could be used. The jaw 128040 comprises a distal end, ortip, 128041 and an elongate profile which narrows from its proximal endto its distal end 128041. Similarly, the jaw 128050 comprises a distalend, or tip, 128051 and an elongate profile which narrows from itsproximal end to its distal end 128051. The distance between the tips128041 and 128051 define the mouth width, or opening, 128032 of the endeffector 128030. When the tips 128041 and 128051 are close to oneanother, or in contact with one another, the mouth 128032 is small, orclosed, and the mouth angle e is small, or zero. When the tips 128041and 128051 are far apart, the mouth 128032 is large and the mouth anglee is large.

Further to the above, the jaws of the end effector 128030 are driven bya jaw drive system including an electric motor. In use, a voltagepotential is applied to the electric motor to rotate the drive shaft ofthe electric motor and drive the jaw drive system. The surgical system128000 comprises a motor control system configured to apply the voltagepotential to the electric motor. In at least one instance, the motorcontrol system is configured to apply a constant DC voltage potential tothe electric motor. In such instances, the electric motor will run at aconstant speed, or an at least substantially constant speed. In variousinstances, the motor control system comprises a pulse width modulation(PWM) circuit and/or a frequency modulation (FM) circuit which can applyvoltage pulses to the electric motor. The PWM and/or FM circuits cancontrol the speed of the electric motor by controlling the frequency ofthe voltage pulses supplied to the electric motor, the duration of thevoltage pulses supplied to the electric motor, and/or the durationbetween the voltage pulses supplied to the electric motor. [3130] Themotor control system is also configured to monitor the current drawn bythe electric motor as a means for monitoring the force being applied bythe jaws of the end effector 128030. When the current being drawn by theelectric motor is low, the loading force on the jaws is low.Correspondingly, the loading force on the jaws is high when the currentbeing drawn by the electric motor is high. In various instances, thevoltage being applied to the electric motor is fixed, or held constant,and the motor current is permitted to fluctuate as a function of theforce loading at the jaws. In certain instances, the motor controlsystem is configured to limit the current drawn by the electric motor tolimit the force that can be applied by the jaws. In at least oneembodiment, the motor control system can include a current regulationcircuit that holds constant, or at least substantially constant, thecurrent drawn by the electric motor to maintain a constant loading forceat the jaws.

The force generated between the jaws of the end effector 128030, and/oron the jaws of the end effector 128030, may be different depending onthe task that the jaws are being used to perform. For instance, theforce needed to hold a suture needle may be high as suture needles aretypically small and it is possible that a suture needle may slip duringuse. As such, the jaws of the end effector 128030 are often used togenerate large forces when the jaws are close together. On the otherhand, the jaws of the end effector 128030 are often used to applysmaller forces when the jaws are positioned further apart to performlarger, or gross, tissue manipulation, for example.

Referring to the upper portion 128110 of the graph 128100 illustrated inFIG. 706 , the loading force, f, experienced by the jaws of the endeffector 128030 can be limited by a force profile stored in the motorcontrol system. The force limit profile 128110 o for opening the jaws128040 and 128050 is different than the force limit profile 128110 c forclosing the jaws 128040 and 128050. This is because the proceduresperformed when forcing the jaws 128040 and 128050 open are typicallydifferent than the procedures performed when forcing the jaws 128040 and128050 closed. That said, the opening and closing force limit profilescould be the same. While it is likely that the jaws 128040 and 128050will experience some force loading regardless of whether the jaws 128050are being opened or closed, the force limit profiles typically come intoplay when the jaws 128040 and 128050 are being used to perform aparticular procedure within the patient. For instance, the jaws 128040and 128050 are forced open to create and expand an otomy in the tissueof a patient, as represented by graph sections 128115 and 128116,respectively, of graph 128100, while the jaws 128040 and 128050 areforced closed to grasp a needle and/or the patient tissue, asrepresented by graph sections 128111 and 128112, respectively, of graph128100.

Referring again to FIG. 706 , the opening and closing jaw force limitprofiles 128110 oand 128110 c, respectively, are depicted on theopposite sides of a zero force line depicted in the graph 128100. As canbe seen in the upper section 128110 of graph 128100, the jaw force limitthreshold is higher—for both force limit profiles 128110 o and 128110c—when the jaws 128040 and 128050 are just being opened from theirfully-closed position. As can also be seen in the upper section 128110of graph 128100, the jaw force limit threshold is lower—for both forcelimit profiles 128110 o and 128110 c—when the jaws 128040 and 128050 arereaching their fully-opened position. Such an arrangement can reduce thepossibility of the jaws 128040 and 128050 damaging adjacent tissue whenthe being fully opened, for example. In any event, the force that thejaws 128040 and 128050 are allowed to apply is a function of the mouthopening size between the jaws and/or the direction in which the jaws arebeing moved. For instance, when the jaws 128040 and 128050 are openedwidely, or at their maximum, to grasp large objects, referring to graphsection 128114 of upper graph section 128110, the jaw force f limit isvery low as compared to when the jaws 128040 and 128050 are more closedto perform gross tissue manipulation, referring to graph section 128113of upper graph section 128110. Moreover, different jaw force limitprofiles can be used for different jaw configurations. For instance,Maryland dissectors, which have narrow and pointy jaws, may have adifferent jaw force limit profile than a grasper having blunt jaws, forexample.

In addition to or in lieu of the above, the speed of the jaws 128040 and128050 can be controlled and/or limited by the motor control system as afunction of the mouth opening size between the jaws 128040 and 128050and/or the direction the jaws are being moved. Referring to the middleportion 128120 and lower portion 128130 of the graph 128100 in FIG. 706, the rate limit profile for moving the jaws 128040 and 128050 permitsthe jaws to be moved slowly when the jaws are near their closed positionand moved quickly when the jaws are near their open position. In suchinstances, the jaws 128040 and 128050 are accelerated as the jaws areopened. Such an arrangement can provide fine control over the jaws128040 and 128050 when they are close together to facilitate the finedissection of tissue, for example. Notably, the rate limit profile foropening and closing the jaws 128040 and 128050 is the same, but theycould be different in other embodiments. In alternative embodiments, therate limit profile for moving the jaws 128040 and 128050 permits thejaws to be moved quickly when the jaws are near their closed positionand slowly when the jaws are near their open position. In suchinstances, the jaws 128040 and 128050 are decelerated as the jaws areopened. Such an arrangement can provide fine control over the jaws128040 and 128050 when the jaws are being used to stretch an otomy, forexample. The above being said, the speed of the jaws 128040 and 128050can be adjusted once the jaws experience loading resistance from thepatient tissue, for example. In at least one such instance, the jawopening rate and/or the jaw closing rate can be reduced once the jaws128040 and 128050 begin to experience force resistance above athreshold, for example.

In various instances, further to the above, the handle of the surgicalsystem 128000 comprises an actuator, the motion of which tracks, or issupposed to track, the motion of the jaws 128040 and 128050 of the endeffector 128030. For instance, the actuator can comprise a scissors-gripconfiguration which is openable and closable to mimic the opening andclosing of the end effector jaws 128040 and 128050. The control systemof the surgical system 128000 can comprise one or more sensor systemsconfigured to monitor the state of the end effector jaws 128040 and128050 and the state of the handle actuator and, if there is adiscrepancy between the two states, the control system can take acorrective action once the discrepancy exceeds a threshold and/orthreshold range. In at least one instance, the control system canprovide feedback, such as audio, tactile, and/or haptic feedback, forexample, to the clinician that the discrepancy exists and/or provide thedegree of discrepancy to the clinician. In such instances, the cliniciancan make mental compensations for this discrepancy. In addition to or inlieu of the above, the control system can adapt its control program ofthe jaws 128040 and 128050 to match the motion of the actuator. In atleast one instance, the control system can monitor the loading forcebeing applied to the jaws and align the closed position of the actuatorwith the position of the jaws when the jaws experience the peak forceloading condition when grasping tissue. Similarly, the control systemcan align the open position of the actuator with the position of thejaws when the jaws experience the minimum force loading condition whengrasping tissue. In various instances, the control system is configuredto provide the clinician with a control to override these adjustmentsand allow the clinician to use their own discretion in using thesurgical system 128000 in an appropriate manner.

A surgical system 128700 is illustrated in FIGS. 707 and 708 . Thesurgical system 128700 comprises a handle, a shaft assembly 128720extending from the handle, and an end effector 128730 extending from theshaft assembly 128720. In alternative embodiments, the surgical system128700 comprises a housing configured to be mounted to a roboticsurgical system. In at least one such embodiment, the shaft 128720extends from the robotic housing mount instead of the handle. In eitherevent, the end effector 128730 comprises shears configured to transectthe tissue of a patient. The shears comprise two jaws 128740 and 128750configured to transect the patient tissue positioned between the jaws128740 and 128750 as the jaws 128740 and 128750 are being closed. Eachof the jaws 128740 and 128750 comprises a sharp edge configured to cutthe tissue and are pivotably mounted to the shaft 128720 about a pivotjoint 128760. Such an arrangement can comprise bypassing scissorsshears. Other embodiments are envisioned in which one of the jaws 128740and 128750 comprises a knife edge and the other comprises a mandrelagainst the tissue is supported and transected. Such an arrangement cancomprise a knife wedge in which the knife wedge is moved toward themandrel. In at least one embodiment, the jaw comprising the knife edgeis movable and the jaw comprising the mandrel is stationary. The abovebeing said, embodiments are envisioned in which the tissue-engagingedges of one or both of the jaws 128740 and 128750 are not necessarilysharp.

As discussed above, the end effector 128730 comprises two scissor jaws128740 and 128750 movable between an open position and a closed positionto cut the tissue of a patient. The jaw 128740 comprises a sharp distalend 128741 and the jaw 128750 comprises a sharp distal end 128751 whichare configured to snip the tissue of the patient at the mouth 128731 ofthe end effector 128730, for example. That said, other embodiments areenvisioned in which the distal ends 128741 and 128751 are blunt and canbe used to dissect tissue, for example. In any event, the jaws aredriven by a jaw drive system including an electric drive motor, thespeed of which is adjustable to adjust the closure rate and/or openingrate of the jaws. Referring to the graph 128400 of FIG. 709 , thecontrol system of the surgical system is configured to monitor theloading, or shear, force on the jaws 128740 and 128750 as the jaws128740 and 128750 are being closed and adaptively slow down the drivemotor when large forces, or forces above a threshold Fc, are experiencedby the jaws 128740 and 128750. Such large forces often occur when thetissue T being cut by the jaws 128740 and 128750 is thick, for example.Similar to the above, the control system can monitor the current drawnby the drive motor as a proxy for the loading force being experienced bythe jaws 128740 and 128750. In addition to or in lieu of this approach,the control system can be configured to measure the jaw loading forcedirectly by one or more load cells and/or strain gauges, for example.Once the loading force experienced by the jaws 128740 and 128750 dropsbelow the force threshold Fc, the control system can adaptively speed upthe jaw closure rate. Alternatively, the control system can maintain thelower closure rate of the jaws 128740 and 128750 even though the forcethreshold is no longer being exceeded.

The above-provided discussion with respect to the surgical system 128700can provide mechanical energy or a mechanical cutting force to thetissue of a patient. That said, the surgical system 128700 is alsoconfigured to provide electrosurgical energy or an electrosurgicalcutting force to the tissue of a patient. In various instances, theelectrosurgical energy comprises RF energy, for example; however,electrosurgical energy could be supplied to the patient tissue at anysuitable frequency. In addition to or in lieu of AC power, the surgicalsystem 128700 can be configured to supply DC power to the patienttissue. The surgical system 128700 comprises a generator in electricalcommunication with one or more electrical pathways defined in theinstrument shaft 128720 which can supply electrical power to the jaws128740 and 128750 and also provide a return path for the current. In atleast one instance, the jaw 128740 comprises an electrode 128742 inelectrical communication with a first electrical pathway in the shaft128720 and the jaw 128750 comprises an electrode 128752 in electricalcommunication with a second electrical pathway in the shaft 128720. Thefirst and second electrical pathways are electrically insulated, or atleast substantially insulated, from one another and the surroundingshaft structure such that the first and second electrical pathways, theelectrodes 128742 and 128752, and the tissue positioned between theelectrodes 128742 and 128752 forms a circuit. Such an arrangementprovides a bipolar arrangement between the electrodes 128742 and 128752.That said, embodiments are envisioned in which a monopolar arrangementcould be used. In such an arrangement, the return path for the currentgoes through the patient and into a return electrode positioned on orunder the patient, for example.

As discussed above, the tissue of a patient can be cut by using amechanical force and/or an electrical force. Such mechanical andelectrical forces can be applied simultaneously and/or sequentially. Forinstance, both forces can be applied at the beginning of a tissuecutting actuation and then the mechanical force can be discontinued infavor of the electrosurgical force finishing the tissue cuttingactuation. Such an approach can apply an energy-created hemostatic sealto the tissue after the mechanical cutting has been completed. In sucharrangements, the electrosurgical force is applied throughout theduration of the tissue cutting actuation. In other instances, themechanical cutting force, without the electrosurgical cutting force, canbe used to start a tissue cutting actuation which is then followed bythe electrosurgical cutting force after the mechanical cutting force hasbeen stopped. In such arrangements, the mechanical and electrosurgicalforces are not overlapping or co-extensive. In various instances, boththe mechanical and electrosurgical forces are overlapping andco-extensive throughout the entire tissue cutting actuation. In at leastone instance, both forces are overlapping and co-extensive throughoutthe entire tissue cutting actuation but in magnitudes or intensitiesthat change during the tissue cutting actuation. The above being said,any suitable combination, pattern, and/or sequence of mechanical andelectrosurgical cutting forces and energies could be used.

Further to the above, the surgical system 128700 comprises a controlsystem configured to co-ordinate the application of the mechanical forceand electrosurgical energy to the patient tissue. In various instances,the control system is in communication with the motor controller whichdrives the jaws 128740 and 128750 and, also, the electrical generatorand comprises one or more sensing systems for monitoring the mechanicalforce and electrosurgical energy being applied to the tissue. Systemsfor monitoring the forces within a mechanical drive system are disclosedelsewhere herein. Systems for monitoring the electrosurgical energybeing applied to the patient tissue include monitoring the impedance, orchanges in the impedance, of the patient tissue via the electricalpathways of the electrosurgical circuit. In at least one instance,referring to the graph 128800 in FIG. 710 , the RF current/voltage ratioof the electrosurgical power being applied to the patient tissue by thegenerator is evaluated by monitoring the current and voltage of thepower being supplied by the generator. The impedance of the tissue andthe RF current/voltage ratio of the electrosurgical power are a functionof many variables such as the temperature of the tissue, the density ofthe tissue, the thickness of the tissue, the type of tissue between thejaws 128740 and 128750, the duration in which the power is applied tothe tissue, among others, which change throughout the application of theelectrosurgical energy.

Further to the above, the control system and/or generator of thesurgical system 128700 comprises one or more ammeter circuits and/orvoltmeter circuits configured to monitor the electrosurgical currentand/or voltage, respectively, being applied to the patient tissue.Referring again to FIG. 710 , a minimum amplitude limit and/or a maximumamplitude limit on the current being applied to the patient tissue canbe preset in the control system and/or can be controllable by the userof the surgical instrument system through one or more input controls.The minimum and maximum amplitude limits can define a current envelopewithin which the electrosurgical portion of the surgical system 128700is operated.

In various instances, the control system of the surgical system 128700is configured to adaptively increase the electrosurgical energy appliedto the patient tissue when the drive motor slows. The motor slowing canbe a reaction to an increase in the tissue cutting load and/or anadaptation of the control system. Similarly, the control system of thesurgical system 128700 is configured to adaptively increase theelectrosurgical energy applied to the patient tissue when the drivemotor stops. Again, the motor stopping can be a reaction to an increasein the tissue cutting load and/or an adaptation of the control system.Increasing the electrosurgical energy when the electric motor slowsand/or stops can compensate for a reduction in mechanical cuttingenergy. In alternative embodiments, the electrosurgical energy can bereduced and/or stopped when the electric motor slows and/or stops. Suchembodiments can afford the clinician to evaluate the situation in alow-energy environment.

In various instances, the control system of the surgical system 128700is configured to adaptively decrease the electrosurgical energy appliedto the patient tissue when the drive motor speeds up. The motor speedingup can be a reaction to a decrease in the cutting load and/or anadaptation of the control system. Decreasing the electrosurgical energywhen the electric motor slows and/or stops can compensate for, orbalance out, an increase in mechanical cutting energy. In alternativeembodiments, the electrosurgical energy can be increased when theelectric motor speeds up. Such embodiments can accelerate the closure ofthe jaws and provide a clean, quick cutting motion.

In various instances, the control system of the surgical system 128700is configured to adaptively increase the speed of the drive motor whenthe electrosurgical energy applied to the patient tissue decreases. Theelectrosurgical energy decreasing can be a reaction to a change intissue properties and/or an adaptation of the control system. Similarly,the control system of the surgical system 128700 is configured toadaptively increase the speed of the drive motor when electrosurgicalenergy applied to the patient tissue stops in response to an adaptationof the control system. Increasing the speed of the drive motor when theelectrosurgical energy decreases or is stopped can compensate for areduction in electrosurgical cutting energy. In alternative embodiments,the speed of the drive motor can be reduced and/or stopped when theelectrosurgical energy decreases and/or is stopped. Such embodiments canafford the clinician to evaluate the situation in a low-energy and/orstatic environment.

In various instances, the control system of the surgical system 128700is configured to adaptively decrease the speed of the electric motorwhen the electrosurgical energy applied to the patient tissue increases.The electrosurgical energy increasing can be a reaction to a change intissue properties and/or an adaptation of the control system. Decreasingthe drive motor speed when the electrosurgical energy increases cancompensate for, or balance out, an increase in electrosurgical cuttingenergy. In alternative embodiments, the drive motor speed can beincreased when the electrosurgical energy increases. Such embodimentscan accelerate the closure of the jaws and provide a clean, quickcutting motion.

In various instances, the surgical system 128700 comprises controls,such as on the handle of the surgical system 128700, for example, that aclinician can use to control when the mechanical and/or electrosurgicalforces are applied. In addition to or in lieu of manual controls, thecontrol system of the surgical system 128700 is configured to monitorthe mechanical force and electrical energy being applied to the tissueand adjust one or the other, if needed, to cut the tissue in a desirablemanner according to one or more predetermined force-energy curves and/ormatrices. In at least one instance, the control system can increase theelectrical energy being delivered to the tissue once the mechanicalforce being applied reaches a threshold limit. Moreover, the controlsystem is configured to consider other parameters, such as the impedanceof the tissue being cut, when making adjustments to the mechanical forceand/or electrical energy being applied to the tissue.

FIG. 711 is a logic diagram of a control system 75000 for use with anyof the various suturing instruments described herein. The control system75000 comprises a control circuit. The control circuit includes amicrocontroller 75040 comprising a processor 75020 and a memory 75030.One or more sensors, such as sensor 75080, sensor 75090, sensor 71502,and sensor array 71940, for example, provide real time feedback to theprocessor 75020. The control system 75000 further comprises a motordriver 75050 configured to control an electric motor 75010 and atracking system 75060 configured to determine the position of one ormore movable components in the suturing instruments, such as a needle,needle drive system, suture, and/or suture spool, for example. Thetracking system 75060 provides position information to the processor75020, which can be programmed or configured to, among other things,determine the position of the suture needle, for example. The motordriver 75050 may be an A3941 available from Allegro Microsystems, Inc.,for example; however, other motor drivers may be readily substituted foruse in the tracking system 75060. A detailed description of an absolutepositioning system is described in U.S. Patent Application PublicationNo. 2017/0296213, entitled SYSTEMS AND METHODS FOR CONTROLLING ASURGICAL STAPLING AND CUTTING INSTRUMENT, the entire disclosure of whichis hereby incorporated herein by reference.

The microcontroller 75040 may be any single core or multicore processorsuch as those known under the trade name ARM Cortex by TexasInstruments, for example. In at least one instance, the microcontroller75040 is a LM4F230H5QR ARM Cortex-M4F Processor Core, available fromTexas Instruments, for example, comprising on-chip memory of 256 KBsingle-cycle flash memory, or other non-volatile memory, up to 40 MHz, aprefetch buffer to improve performance above 40 MHz, a 32 KBsingle-cycle serial random access memory (SRAM), internal read-onlymemory (ROM) loaded with StellarisWare® software, 2 KB electricallyerasable programmable read-only memory (EEPROM), one or more pulse widthmodulation (PWM) modules and/or frequency modulation (FM) modules, oneor more quadrature encoder inputs (QEI) analog, one or more 12-bitAnalog-to-Digital Converters (ADC) with 12 analog input channels, forexample, details of which are available from the product datasheet.

In various instances, the microcontroller 75040 comprises a safetycontroller comprising two controller-based families such as TMS570 andRM4x known under the trade name Hercules ARM Cortex R4, also by TexasInstruments. The safety controller may be configured specifically forIEC 61508 and ISO 26262 safety critical applications, among others, toprovide advanced integrated safety features while delivering scalableperformance, connectivity, and memory options.

The microcontroller 75040 is programmed to perform various functionssuch as precisely controlling the speed and/or position of the sutureneedle, for example. The microcontroller 75040 is also programmed toprecisely control the rotational speed and position of the end effectorof the suturing instrument and the articulation speed and position ofthe end effector of the suturing instrument. In various instances, themicrocontroller 75040 computes a response in the software of themicrocontroller 75040. The computed response is compared to a measuredresponse of the actual system to obtain an “observed” response, which isused for actual feedback decisions. The observed response is afavorable, tuned, value that balances the smooth, continuous nature ofthe simulated response with the measured response, which can detectoutside influences on the system.

The motor 75010 is controlled by the motor driver 75050. In variousforms, the motor 75010 is a DC brushed driving motor having a maximumrotational speed of approximately 25,000 RPM, for example. In otherarrangements, the motor 75010 includes a brushless motor, a cordlessmotor, a synchronous motor, a stepper motor, or any other suitableelectric motor. The motor driver 75050 may comprise an H-bridge drivercomprising field-effect transistors (FETs), for example. The motordriver 75050 may be an A3941 available from Allegro Microsystems, Inc.,for example. The A3941 motor driver 75050 is a full-bridge controllerfor use with external N-channel power metal oxide semiconductor fieldeffect transistors (MOSFETs) specifically designed for inductive loads,such as brush DC motors. In various instances, the motor driver 75050comprises a unique charge pump regulator provides full (>10 V) gatedrive for battery voltages down to 7 V and allows the A3941 motor driver75050 to operate with a reduced gate drive, down to 5.5 V. A bootstrapcapacitor may be employed to provide the above-battery supply voltagerequired for N-channel MOSFETs. An internal charge pump for thehigh-side drive allows DC (100% duty cycle) operation. The full bridgecan be driven in fast or slow decay modes using diode or synchronousrectification. In the slow decay mode, current recirculation can bethrough the high-side or the lowside FETs. The power FETs are protectedfrom shoot-through by resistor adjustable dead time. Integrateddiagnostics provide indication of undervoltage, overtemperature, andpower bridge faults, and can be configured to protect the power MOSFETsunder most short circuit conditions. Other motor drivers may be readilysubstituted.

The tracking system 75060 comprises a controlled motor drive circuitarrangement comprising one or more position sensors, such as the sensor75080, sensor 75090, sensor 71502, and sensory array 71940, for example.The position sensors for an absolute positioning system provide a uniqueposition signal corresponding to the location of a displacement member.As used herein, the term displacement member is used generically torefer to any movable member of any of the surgical instruments disclosedherein. In various instances, the displacement member may be coupled toany position sensor suitable for measuring linear displacement orrotational displacement. Linear displacement sensors may include contactor non-contact displacement sensors. The displacement sensors maycomprise linear variable differential transformers (LVDT), differentialvariable reluctance transducers (DVRT), a slide potentiometer, amagnetic sensing system comprising a movable magnet and a series oflinearly arranged Hall Effect sensors, a magnetic sensing systemcomprising a fixed magnet and a series of movable linearly arranged HallEffect sensors, an optical sensing system comprising a movable lightsource and a series of linearly arranged photo diodes or photodetectors, or an optical sensing system comprising a fixed light sourceand a series of movable linearly arranged photo diodes or photodetectors, or any combination thereof.

The position sensors 75080, 75090, 71502, and 71940 for example, maycomprise any number of magnetic sensing elements, such as, for example,magnetic sensors classified according to whether they measure the totalmagnetic field or the vector components of the magnetic field. Thetechniques used to produce both types of magnetic sensors encompass manyaspects of physics and electronics. The technologies used for magneticfield sensing include search coil, fluxgate, optically pumped, nuclearprecession, SQUID, Hall-Effect, anisotropic magnetoresistance, giantmagnetoresistance, magnetic tunnel junctions, giant magnetoimpedance,magnetostrictive/piezoelectric composites, magnetodiode,magnetotransistor, fiber optic, magnetooptic, and microelectromechanicalsystems-based magnetic sensors, among others.

In various instances, one or more of the position sensors of thetracking system 75060 comprise a magnetic rotary absolute positioningsystem. Such position sensors may be implemented as an AS5055EQFTsingle-chip magnetic rotary position sensor available from AustriaMicrosystems, AG and can be interfaced with the controller 75040 toprovide an absolute positioning system. In certain instances, a positionsensor comprises a low-voltage and low-power component and includes fourHall-Effect elements in an area of the position sensor that is locatedadjacent a magnet. A high resolution ADC and a smart power managementcontroller are also provided on the chip. A CORDIC processor (forCoordinate Rotation Digital Computer), also known as the digit-by-digitmethod and Volder's algorithm, is provided to implement a simple andefficient algorithm to calculate hyperbolic and trigonometric functionsthat require only addition, subtraction, bitshift, and table lookupoperations. The angle position, alarm bits, and magnetic fieldinformation are transmitted over a standard serial communicationinterface such as an SPI interface to the controller 75040. The positionsensors can provide 12 or 14 bits of resolution, for example. Theposition sensors can be an AS5055 chip provided in a small QFN 16-pin4×4×0.85 mm package, for example.

The tracking system 75060 may comprise and/or be programmed to implementa feedback controller, such as a PID, state feedback, and adaptivecontroller. A power source converts the signal from the feedbackcontroller into a physical input to the system, in this case voltage.Other examples include pulse width modulation (PWM) and/or frequencymodulation (FM) of the voltage, current, and force. Other sensor(s) maybe provided to measure physical parameters of the physical system inaddition to position. In various instances, the other sensor(s) caninclude sensor arrangements such as those described in U.S. Pat. No.9,345,481, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM,which is hereby incorporated herein by reference in its entirety; U.S.Patent Application Publication No. 2014/0263552, entitled STAPLECARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, which is hereby incorporatedherein by reference in its entirety; and U.S. patent application Ser.No. 15/628,175, entitled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTORVELOCITY OF A SURGICAL STAPLING AND CUTTING INSTRUMENT, which is herebyincorporated herein by reference in its entirety. In a digital signalprocessing system, absolute positioning system is coupled to a digitaldata acquisition system where the output of the absolute positioningsystem will have finite resolution and sampling frequency. The absolutepositioning system may comprise a compare and combine circuit to combinea computed response with a measured response using algorithms such asweighted average and theoretical control loop that drives the computedresponse towards the measured response. The computed response of thephysical system takes into account properties like mass, inertial,viscous friction, inductance resistance, etc., to predict what thestates and outputs of the physical system will be by knowing the input.

The absolute positioning system provides an absolute position of thedisplacement member upon power up of the instrument without retractingor advancing the displacement member to a reset (zero or home) positionas may be required with conventional rotary encoders that merely countthe number of steps forwards or backwards that the motor 75010 has takento infer the position of a device actuator, the needle driver, and thelike.

A sensor 75080 and/or 71502 comprising a strain gauge or a micro-straingauge, for example, is configured to measure one or more parameters ofthe end effector of the suturing instrument, such as, for example, thestrain experienced by the needle during a suturing operation. Themeasured strain is converted to a digital signal and provided to theprocessor 75020. A sensor 75090 comprising a load sensor, for example,can measure another force applied by the suturing instrument. In variousinstances, a current sensor 75070 can be employed to measure the currentdrawn by the motor 75010. The force required to throw, or rotate, thesuturing needle can correspond to the current drawn by the motor 75010,for example. The measured force is converted to a digital signal andprovided to the processor 75020. A magnetic field sensor can be employedto measure the thickness of the captured tissue. The measurement of themagnetic field sensor can also be converted to a digital signal andprovided to the processor 75020.

The measurements of the tissue thickness and/or the force required torotate the needle through tissue as measured by the sensors can be usedby the controller 75040 to characterize the position and/or speed of themovable member being tracked. In at least one instance, the memory 75030may store a technique, an equation, and/or a look-up table which can beemployed by the controller 75040 in the assessment. In variousinstances, the controller 75040 can provide the user of the suturinginstrument with a choice as to the manner in which the suturinginstrument should be operated. To this end, a display 75044 can displaya variety of operating conditions of the suturing instrument and caninclude touch screen functionality for data input. Moreover, informationdisplayed on the display 75044 may be overlaid with images acquired viathe imaging modules of one or more endoscopes and/or one or moreadditional surgical instruments used during the surgical procedure.

As discussed above, the suturing instruments disclosed herein maycomprise control systems. Each of the control systems can comprise acircuit board having one or more processors and/or memory devices. Amongother things, the control systems are configured to store sensor data,for example. They are also configured to store data which identifies thetype of suturing instrument attached to a handle or housing. Morespecifically, the type of suturing instrument can be identified whenattached to the handle or housing by the sensors and the sensor data canbe stored in the control system. Moreover, they are also configured tostore data including whether or not the suturing instrument has beenpreviously used and/or how many times the suture needle has been cycled.This information can be obtained by the control system to assess whetheror not the suturing instrument is suitable for use and/or has been usedless than a predetermined number of times, for example.

The devices, systems, and methods disclosed in the Subject Applicationcan be used with the devices, systems, and methods disclosed in U.S.patent application Ser. No. 13/832,786, now U.S. Pat. No. 9,398,905,entitled CIRCULAR NEEDLE APPLIER WITH OFFSET NEEDLE AND CARRIER TRACKS;U.S. patent application Ser. No. 14/721,244, now U.S. Patent ApplicationPublication No. 2016/0345958, entitled SURGICAL NEEDLE WITH RECESSEDFEATURES; and U.S. patent application Ser. No. 14/740,724, now U.S.Patent Application Publication No. 2016/0367243, entitled SUTURINGINSTRUMENT WITH MOTORIZED NEEDLE DRIVE, which are incorporated byreference in their entireties herein.

The surgical instrument systems described herein can be used inconnection with the deployment of suture material to seal tissue.Moreover, various embodiments are envisioned which utilize any suitablemeans for sealing tissue. For instance, an end effector in accordancewith various embodiments can comprise electrodes configured to heat andseal the tissue. Also, for instance, an end effector in accordance withcertain embodiments can apply vibrational energy to seal the tissue. Inaddition, various embodiments are envisioned which utilize a suitablecutting means to cut the tissue.

Sterilization processes are part of customary surgical preparationprocedures. A variety of sterilization processes exist for surgicalinstruments. Various methods include sterilization by way of autoclavewhich utilizes high heat and pressure, and sterilization utilizingsteam, dry heat, and/or radiation, for example. However, one of the mostwidely used methods of sterilization is ethylene oxide processing.Ethylene oxide is an alkylating chemical compound which inhibits anddisrupts the DNA of microorganisms in order to prevent reproduction ofthose organisms. Ethylene oxide processing is a highly effectivesterilization process, but it does not come without cost. Some of theearly steps involved during ethylene oxide processing involve heatingthe surgical instruments to a sustainable internal temperature andhumidifying the surgical instruments. Often times, the surgicalinstruments undergo the heating and humidifying processes for anywherefrom twelve to seventy-two hours during a single sterilization process.In addition to the heat and humidity, the potency of ethylene oxidetends to affect the soft electronic circuitry of powered surgicalinstruments. In the field of endoscopy, certain components of thepowered endoscopy surgical instruments, such as display screens, forexample, react poorly to the sterilization process when ethylene oxideis used. Improperly functioning display screens could result indifficulties and/or delays during a surgical procedure. Thus, a needexists for a surgical instrument system which incorporates a variety ofcost-efficient disposable and replaceable components in order to avoidthe damage caused by the sterilization process.

A surgical instrument system is illustrated in FIG. 712 . The surgicalinstrument system illustrated in FIG. 712 is similar to the surgicalinstrument system depicted in FIG. 503 in many respects, most of whichwill not be repeated herein out of the sake of brevity. The surgicalinstrument system comprises a variety of interchangeable shaftassemblies and power modules, as will be discussed in greater detailbelow. The surgical instrument system comprises a handle assembly 11000.The handle assembly 11000 is usable with a variety of interchangeableshaft assemblies, such as a shaft assembly 12000, a shaft assembly13000, a shaft assembly 14000, a shaft assembly 15000, and/or other anyother suitable shaft assembly. The interchangeable shaft assemblies12000, 13000, 14000, and 15000 are similar to the shaft assemblies 2000,3000, 4000, and 5000 in many respects. Similar to the shaft assembly2000, the shaft assembly 12000 comprises a proximal end portion 12100and an elongate shaft 12200 extending from the proximal end portion12100. The shaft assembly 12000 also comprises an end effector 12400which is rotatably attached to the elongate shaft 12200 by anarticulation joint 12300. The end effector 12400 comprises a first jaw17000 and a second jaw 17100. Similar to the shaft assembly 12000, theshaft assembly 13000 comprises a proximal end portion 13100, and anelongate shaft 13200 extending from the proximal end portion 13100. Theshaft assembly 13000 is also configured for use with the end effector12400 which is rotatably attached to the elongate shaft 13200 by anarticulation joint 12300. Similar to the shaft assembly 12000, the shaftassembly 14000 comprises a proximal end portion 14100, and an elongateshaft 14200 extending from the proximal end portion 14100. The shaftassembly 14000 is also configured for use with an end effector 12400′which is rotatably attached to the elongate shaft 14200 by anarticulation joint 12300. The end effector 12400′ comprises a first jaw18000 and a second jaw 18100. The shaft assembly 15000 comprises similarcomponents to those of the shaft assemblies 12000, 13000, and 14000,many of which will not be discussed in detail for the sake of brevity.

Still referring to FIG. 712 , the handle assembly 11000 comprises adrive module 11100. The drive module 11100 comprises a distal mountinginterface 11130 which allows for the selective and separate engagementof any one of the shaft assemblies 12000, 13000, 14000, and 15000 withthe drive module 11100. Each of the shaft assemblies 12000, 13000,14000, and 15000 comprises the same or a substantially similar proximalmounting interface which is configured to engage the distal mountinginterface of the drive module 11100. Still referring to FIG. 712 , theshaft assembly 12000 comprises a proximal mounting interface 12130 whichis configured for attachment to the distal mounting interface 11130 ofthe drive module 11100 by at least one latch 11140 of the drive module11100. Similarly, the shaft assembly 13000 comprises a proximal mountinginterface 13130 which is configured for attachment to the distalmounting interface 11130 of the drive module 11100 by at least one latch11140 of the drive module 11100. Also, similarly, the shaft assembly14000 comprises a proximal mounting interface 14130 which is configuredfor attachment to the distal mounting interface 11130 of the drivemodule 11100 by at least one latch 11140 of the drive module 11100.Likewise, the shaft assembly 15000 comprises a proximal mountinginterface 15130 which is configured for attachment to the distalmounting interface 11130 of the drive module 11100. The drive module11100 is configured to electrically couple to each of the shaftassembles 12000, 13000, 14000, and 15000. The surgical instrument systemcomprises a motor positioned in the handle assembly 11000, as will bediscussed in greater detail below. Each of the shaft assemblies 12000,13000, 14000, and 15000 comprises a control circuit as will be discussedin greater detail below. The control circuit is configured to interactwith the motor in order to control various functions of the surgicalinstrument system. The surgical instrument system further comprises amotor-control processor which is configured to communicate with thecontrol circuit in order to control the motor. Referring to FIG. 745 ,the processor is positioned in any suitable portion of the surgicalinstrument apart from the drive module 11100. For example, the processoris positioned in a shaft assembly of the surgical instrument system. Thehandle assembly 11000 is configured for use with at least one powermodule as will be discussed in greater detail below.

Referring to FIGS. 712 and 713 , the drive module 11100 comprises ahousing 11110 which is capable of use with a variety of power modulessuch as the power modules 11200 and 11300, for example. In variousinstances, each power module 11200 and 11300 comprises one or morebattery cells, as illustrated in FIG. 713 , which are configured toenable pistol, scissor, and/or pencil grip configurations comprisingdifferent load requirements. In particular, the housing 11110 comprisesa first attachment portion 11120 and a second attachment portion 11120′which are configured to engage either the power module 11200 or thepower module 11300 at either the bottom of the handle assembly 11000 orthe proximal end of the handle assembly 11000 depending on which shaftassembly is attached to the handle assembly 11000. For example, when theshaft assembly 14000 is attached to the handle assembly 11000, a powermodule is attached to the proximal end of the handle assembly 11000 in afirst configuration as illustrated in FIG. 712 . As another example,when the shaft assembly 13000 is attached to the handle assembly 11000,a power module is attached to the bottom of the handle assembly 11000 ina second configuration. As illustrated in FIGS. 712 and 713 , the firstconfiguration and the second configuration are different from oneanother.

Still referring to FIG. 713 , the drive module 11100 comprises arotation actuator 11420 which is similar to the rotation actuator 1420,which is described in greater detail above. The drive module 11100further comprises release actuators 11150 which, when depressed by aclinician, move the latches 11140 from their locked positions into theirunlocked positions. The drive module 11100 comprises a first releaseactuator 11150 slideably mounted in an opening defined in the first sideof the handle housing 11110 and a second release actuator 11150slideably mounted in an opening defined in a second, or opposite, sideof the handle housing 11110.

Referring to FIGS. 713 and FIG. 714 , the drive module 11100 comprisesan articulation actuator 11430. The articulation actuator 11430comprises a first push button 11432 and a second push button 11434. Thefirst push button 11432 is part of a first articulation control circuitand the second push button 11434 is part of a second articulationcircuit of an input system similar to the input system 1400 discussed ingreater detail above.

Referring again to FIG. 712 , the surgical instrument system comprises apower module 11200. The power module 11200 comprises a housing 11210, aconnector portion 11220, and at least one battery (as illustrated in atleast FIG. 713 ). The connector portion 11220 is configured to beengaged with the first connector portion 11120 in order to attach thepower module 11200 to the bottom of the handle assembly 11000. The powermodule 11200 comprises at least one latch 11240 positioned at the top ofthe power module 11200 which is configured to secure the power module11200 to the bottom of the drive module 11100. More specifically, thelatch 11240 is configured to securely attach the housing 11210 of thepower module 11200 to the housing 11110 of the drive module 11100located within the handle assembly 11000. The connector portion 11220comprises a plurality of electrical contacts which enable an electricalconnection between the power module 11200 and the drive module 11100.The power module 11200 comprises a release latch 11250 which isconfigured to release the power module 11250 from the drive module11000.

Referring again to FIG. 712 , the surgical instrument system comprises apower module 11300. The power module 11300 comprises a housing 11310, aconnector portion 11320, and at least one battery. The connector portion11320 is configured to be engaged with the second connector portion11120′ in order to attach the power module 11300 to the handle assembly11000. The power module 11300 comprises at least one latch 11340positioned at a distal end of the power module 11300 which is configuredto secure the power module 11300 to the drive module 11100. Morespecifically, the latch 11340 is configured to securely attach thehousing 11310 of the power module 11300 to the housing 11110 of thedrive module 11100 located within the handle assembly 11000. Theconnector portion 11320 comprises a plurality of electrical contactswhich enable an electrical connection between the power module 11300 andthe drive module 11100.

Still referring to FIG. 712 , the power module 11200 and the powermodule 11300 each comprise at least one display unit. The power module11200 comprises a display unit 11440 located on the power module housing11210. The power module 11300 comprises a display unit 11440′. Thedisplay units 11440 and 11440′ can comprise any suitable display screen,for example, configured for use with a powered surgical device. Invarious instances, the display units 11440 and 11440′ comprise anelectrochromic display. The electrochromic display comprises an array ofelectrodes created from a metal oxide semi conductor. The electrodes aremounted on a flexible film comprising attachments of electrochromicmolecules. As a charge is applied to the semiconducting electrodes, theelectrochromic molecules travel to the surface of the film to receivethe charge. As the electrochromic molecules are charged, a change incolor occurs in the molecules. Suitable versions of this type of displayscreen are available from Ntera and Seiko, for instance.

In certain instances, the display units 11440 and 11440′ comprise anelectrophoretic display. The electrophoretic display comprises titaniumdioxide particles approximately one micrometer in diameter which aredispersed in a hydrocarbon oil, for example. A dark-colored dye is alsoadded to the oil, along with surfactants and charging agents that causethe particles to take on an electric charge. The mixture of titaniumdioxide particles and hydrocarbon oil is placed between two parallelconductive plates separated by a gap of 10 to 100 micrometers, forexample. The parallel conductive plates comprise opposite charges fromone another. When a voltage is applied across the two plates, thetitanium dioxide particles migrate electrophoretically to the plate thatbears the opposite charge from the charge of the particles. When theparticles are located at the front (viewing) side of the display, itappears white, because light is scattered back to the viewer by thehigh-index titanium dioxide particles. When the particles are located atthe rear side of the display, it appears dark, because the incidentlight is absorbed by the colored dye. If the rear electrode is dividedinto a number of small picture elements (pixels), then an image can beformed by applying the appropriate voltage to each region of the displayto create a pattern of reflecting and absorbing regions.

Other suitable variations of display screens include various types ofliquid-crystal displays including liquid-crystal character displaymodules, thin film transistor liquid-crystal displays, and/or any othersuitable display screens. Liquid crystal character display modules areflat-panel displays which use the light-modulating properties of liquidcrystals in order to produce images in color or monochrome by using abacklight or a reflector. Thin film transistor liquid-crystal displaysuse thin-film transistor technology to provide for improved imagequalities including, but not limited to, contrast. Additional types ofdisplay screens comprise touch screen capable screens and/or activematrix backplanes comprising an amorphous silicon semiconductor or apolythiophene semiconductor, for example.

Referring primarily to FIG. 713 , the power module 11200 is attached tothe handle assembly 11000 in a first orientation. When the power module11200 is positioned in the first orientation, a first maximum level ofpower is supplied to the surgical instrument system. As seen in FIG. 713, the surgical instrument system comprises a pistol grip when the powermodule 11200 is attached to the surgical instrument. Still referring toFIG. 713 , the power module 11200 comprises at least a first battery11230 and a second battery 11260. Referring to FIG. 714 , the powermodule 11300 comprises a housing 11310 which is configured to attach thepower module 11300 to the handle assembly 11000 in a second orientation.The second orientation of the power module 11300 is configured to supplyan appropriate amount of power when the surgical instrument comprises apencil or wand grip configuration. The power module 11200 is configuredto supply more power to the surgical instrument when the power 11200 isin the first orientation, and the power module 11300 is configured tosupply less power to the surgical instrument in the second orientation.The use of various power modules ensures that the necessary amount ofpower for the operation of the surgical instrument system is provided.With respect to FIGS. 714-716 , the drive module 11100 comprises thesame and/or similar components as the drive module 1100 discussed indetail above with respect to FIGS. 509-511 . That is, the drive module11100 interacts with each of the shaft assemblies 12000, 13000, 14000,and 15000 in the same and/or a similar manner as the drive module 1100interacts with the shaft assemblies 2000, 3000, 4000, and 5000.

FIGS. 717-719 illustrate the surgical instrument system comprising thepower module 11300 in the first orientation for use with the scissorgrip configuration of the shaft assembly 14000. The surgical instrumentsystem illustrated in FIGS. 717-719 is similar in some aspects to thesurgical instrument system illustrated in FIGS. 548-550 , which isdiscussed in greater detail above and is also configured for use withthe power module 11300 which comprises the display unit 11440′. Varioussurgical instruments described herein are compatible with the powermodules 11200 and 11300.

Turning now to FIG. 720 , a surgical instrument system can comprise avariety of handle assemblies such as a pencil grip handle, a scissorgrip handle, a pistol grip handle, among others, and a shaft assembly,such as the shaft assembly 20000, for example, that can be used witheach of the handle assemblies. The surgical instrument system comprisesa first handle assembly 21000, which is a pencil grip handle. Referringprimarily to FIGS. 721 and 729 , the first handle assembly 21000comprises one electric drive motor, a first drive shaft 21100, and afirst set of controls which controls the one electric drive motor. Thedrive shaft 21100 of the one drive motor is configured to be coupledwith a drive system of the shaft assembly 20000 when the shaft assembly20000 is attached to the handle assembly 21000. The drive motor used inconnection with the surgical instrument system of FIG. 720 is similar inmany respects to other motors discussed in detail above, such as themotor 1610, for example. The first handle assembly 21000 furthercomprises a plurality of electrical contacts 21022 for placing thehandle assembly 21000 in electrical communication with the shaftassembly 20000 via electrical contacts 20022 defined thereon. Referringto FIGS. 720 and 721 , the first handle assembly 21000 further comprisesan insertable power module 21020 at the proximal end of the handleassembly 21000.

The surgical instrument system further comprises a second handleassembly 22000, which is a scissors grip handle. Referring primarily toFIG. 722 , the second handle assembly 22000 comprises first and secondelectric drive motors, a drive shaft 22100, a second drive shaft 22200,a first set of controls which controls the first drive motor, and asecond set of controls which controls the second drive motor. The firstdrive shaft 22100 and the second drive shaft 22200 of the first andsecond drive motors can be coupled with two drive systems of the shaftassembly 20000. The first and second drive motors are similar in manyrespects to other motors discussed in detail above, such as the motor1610, for example. The second handle assembly 22000 further comprises aplurality of electrical contacts 22022 for placing the handle assembly22000 in electrical communication with the shaft assembly 20000 viaelectrical contacts 20022 defined thereon as seen in FIG. 724 .Referring primarily to FIGS. 720 and 722 , the second handle assembly22000 further comprises an insertable power module 22020 at the proximalend of the handle assembly 22000.

Referring to FIGS. 720 and 723 , the surgical instrument system furthercomprises a third handle assembly 23000, which is a pistol grip handle.The third handle assembly 23000 comprises first, second, and thirdelectric drive motors, a first drive shaft 23100, a second drive shaft23200, a third drive shaft 23300, a first set of controls which controlsthe first drive motor, a second set of controls which controls thesecond drive motor, and a third set of controls which controls the thirddrive motor. The third handle assembly 23000 comprises a third set ofcontrols. The first drive shaft 23100, the second drive shaft 23200, andthe third drive shaft 23300 can be coupled with the three drive systemsof the shaft assembly 20000. The third handle assembly 23000 furthercomprises a plurality of electrical contacts 23022 for placing thehandle assembly 23000 in electrical communication with the shaftassembly 20000 via electrical contacts 20022 defined thereon as seen inFIGS. 723 and 727 . The third handle assembly 23000 further comprises aninsertable power module 23020 at the proximal end of the handle assembly23000.

Further to the above, the shaft assembly 20000 comprises three drivesystems which are drivable by a drive motor of a handle assembly—thisis, of course, assuming that the handle assembly that the shaft assembly20000 is attached to has a sufficient number of drive motors to driveall three drive systems of the shaft assembly 20000. Stated another way,the first handle assembly 21000 has only one drive motor to drive one ofthe drive systems of the shaft assembly 20000 and, similarly, the secondhandle assembly 22000 has only two drive motors to drive two of thedrive systems of the shaft assembly 20000. Thus, two drive systems ofthe shaft assembly 20000 cannot be driven by the first handle assembly21000 and one drive system of the shaft assembly 20000 cannot be drivenby the second handle assembly 22000. In various instances, the undrivensystem, or systems, of the shaft assembly 20000 can remain inert whilethe other drive system, or systems, of the shaft assembly 20000 arebeing used. In at least one embodiment, the handle assemblies 21000 and22000 can be configured to lock out the drive systems of the shaftassembly 20000 that aren't being used. In at least one instance, thehandle assembly 21000 comprises two stationary posts extending therefromwhich engage the second and third drive systems of the shaft assembly20000 when the shaft assembly 20000 is assembled to the handle assembly21000. The stationary posts prevent the second and third drive systemsof the shaft assembly 20000 from being unintentionally actuated.Similarly, the handle assembly 22000 comprises one stationary postextending therefrom which engages the third drive system of the shaftassembly 20000 to prevent the third drive system from beingunintentionally actuated. The third handle assembly 23000 does notcomprise stationary posts to lock a drive system of the shaft assembly20000 as all three drive systems of the shaft assembly 20000 are coupledto a drive motor in the third handle assembly 23000.

In addition to or in lieu of the above, the shaft assembly 20000 cancomprise a second lock that is biased into a locked configuration tolock the second drive system in place and a third lock that is biasedinto a locked configuration to lock the third drive in place. When theshaft assembly 20000 is attached to the first handle assembly 21000, theshaft assembly 20000 does not receive electrical power from the firsthandle assembly 21000 to unlock the second lock or the third lock. Whenthe shaft assembly 20000 is attached to the second handle assembly22000, the shaft assembly 20000 receives electrical power from thesecond handle assembly 22000, via the electrical contacts 22022, and thesecond lock is unlocked so that the second drive system of the shaftassembly 20000 can be used by the second handle assembly 22000. Thatsaid, the second handle assembly 22000 does not receive electrical powerfrom the second handle assembly 22000 to unlock the third lock as thesecond and third locks are part of separate and distinct circuits. Whenthe shaft assembly 20000 is attached to the third handle assembly 23000,the shaft assembly 20000 receives power from the third handle assembly23000, via the electrical contacts 23022, to unlock the second and thirdlocks so that the second and third drive systems of the shaft assembly20000 can be used by the third handle assembly 23000.

As discussed above and referring to FIG. 720 , the shaft assembly 20000is selectively attachable to the first handle assembly 21000, the secondhandle assembly 22000, and the third handle assembly 23000. That beingsaid, the handle assemblies 21000, 22000, and 23000 are all configuredto be held differently by a clinician. The pen configuration of thefirst handle assembly 21000 is configured to be held, or pinched,between the clinician's thumb and index finger on one hand. The scissorsconfiguration of the second handle assembly 22000 is configured to begripped by an outstretched hand of the clinician. The pistolconfiguration of the third handle assembly 23000 is configured to begripped by a closed, clenched hand of the clinician. As a result, thehandle configurations 21000, 22000, and 23000 can be configured suchthat the shaft assembly 20000 is attached thereto in differentorientations to match the grip orientation of the clinician's hand. Forinstance, the shaft assembly 20000 is attached to the handle assembly21000 in a first orientation and attached to the shaft assemblies 22000and 23000 in a second orientation which is rotated 90 degrees from thefirst orientation. Such an arrangement matches the typical expectationsof the clinician regarding the orientation of the shaft assembly 20000relative to their hand. Similarly, the first set of controls on thefirst handle assembly 21000 for controlling the first drive motor can beoriented 90 degrees relative to the orientation of the first set ofcontrols on the second handle assembly 22000 and the third handleassembly 23000. Moreover, it can be desirable for a certain function ofthe shaft assembly 20000 to be always coupled to a motor-driven drivesystem regardless of the handle assembly that it is attached to. Toachieve this, in various instances, the shaft assembly 20000 may have tobe attached to the handles 21000, 22000, and 23000 in differentorientations to align the articulation drive system, for example, to amotor-driven drive system.

Further information regarding the different configurations of the handleassemblies 21000, 22000, and 23000 are presented in FIG. 733 . Forexample, the pencil handle assembly 21000 comprises a motor-drivenoutput which is configured to enable right and left articulation of theshaft 20400. The end effector can be manually rotated relative to theshaft 20400. The pencil handle assembly 21000 is not configured toperform any actuation motions of the end effector or rotation of theshaft 20400 as it does not comprise a motor driven output for theactuation motions of the end effector or the rotation of the shaft20400. As another example, the scissor grip handle assembly 22000comprises a motor-driven output which is configured to enable right andleft articulation of the shaft 20400. The scissor grip handle assembly22000 comprises another motor-driven output which is configured toenable a first actuation motion of the end effector. The scissor griphandle assembly 22000 is not configured to perform a second actuationmotion of the end effector or rotation of the shaft 20400 as it does notcomprise a motor-driven output for the second actuation motion of theend effector or the rotation of the shaft 20400. As another example, thepistol handle assembly 23000 comprises motor-driven outputs which areconfigured to enable right and left articulation of the shaft 20400. Thepistol handle assembly also comprises motor-driven outputs which areconfigured to enable the first and second actuation motions of the endeffector as well as rotation of the shaft 20400 via a motor and ashiftable transmission.

Referring primarily to FIGS. 724 and 732 , a handle assembly 24000,which is similar to the handle assembly 22000 in many respects,comprises at least one spring loaded pin 24024 which is configured toflex to allow the shaft assembly 20000 to be releasably held to theshaft assembly 20000. Such an arrangement can be adapted to the handleassemblies 21000, 22000, and 23000 to releasably hold the shaft assembly20000 thereto. Similar to the handle assembly 22000, the handle assembly24000 comprises a set of electrical contacts 24022, a first drive shaft24100, and a second drive shaft 24200.

As discussed above, the shaft assembly 20000 comprises a first driveshaft 20100, a second drive shaft 20200, and a third drive shaft 20300,each of which enables a particular function of the surgical instrumentsystem by establishing a mechanical connection with a drive shaft in anyone of the handle assemblies 21000, 22000, and 23000—so long as thehandle assembly has a sufficient number of drives to be coupled to.While the shaft assembly 20000 is attached to the first handle assembly21000, certain functions of the surgical instrument and/or the endeffector are enabled and certain functions of the surgical instrumentand/or the end effector are locked out as seen in FIG. 733 and describedin greater detail above. For example, the first handle assembly 21000can drive the articulation system of the shaft 20400 with its one drivemotor. All other functions of the shaft assembly 20000 would have to beperformed by the manual manipulation of the first handle assembly 21000.Referring primarily to FIG. 720 , the pencil grip configuration of thehandle assembly 21000 does not afford a motor-driven output foractuating the end effector and/or rotating the shaft 20400.

The second handle assembly 22000 comprises two motors configured todrive two of the drives of the shaft assembly 20000. While the shaftassembly 20000 is attached to the second handle assembly 22000, certainfunctions of the surgical instrument and/or the end effector are enabledand certain functions of the surgical instrument and/or the end effectorare locked out as seen in Table A of FIG. 733 and described in greaterdetail above. The first motor of the second handle assembly 22000 drivesthe articulation drive of the shaft assembly 20000 and the second motorof the second handle assembly 22000 drives a jaw assembly of the shaftassembly 20000 to move the jaw assembly between open and closedconfigurations. The third function of the shaft assembly 20000, i.e.,the rotation of the jaw assembly about a longitudinal axis must beperformed manually by rotating the second handle assembly 22000 aboutthe longitudinal axis. The third handle assembly 23000 comprises threemotors configured to drive all three of the drives of the shaft assembly20000. While the shaft assembly 20000 is attached to the third handleassembly 23000 in the third orientation, none of the functions of thesurgical instrument and/or the end effector are locked out as seen inTable A of FIG. 733 and described in greater detail above.

Referring to FIG. 734 , the third handle assembly 23000 comprises apistol grip configured for use with a smoke evacuation tube 23400. Thesmoke evacuation tube 23400 is configured to fit inside a groove 23420within the handle assembly 23000. The shaft assembly 20000 furthercomprises a smoke evacuation tube 20410 which fits over the shaft 20400.Referring to FIG. 735 , the third handle assembly 23000 comprises afirst motor 23062 configured to power the right and left articulation ofthe end effector. The third handle assembly comprises a second motorconfigured to power the jaw drive of the shaft assembly 20000. The thirdhandle assembly 23000 comprises a third motor configured to power therotation of the end effector about the longitudinal axis. The handleassembly 23000 further comprises a first gear box 23064 to reduce thespeed of the first motor and a second gear box 23068 to reduce the speedof the second motor. Still referring to FIG. 735 , the insertable powermodule 23020 comprises at least two battery cells 23040 and 23050.

Referring to FIG. 736 , the second handle assembly 22000 comprises ascissor grip configuration for use with a smoke evacuation tube 22400.The smoke evacuation tube 22400 is configured to fit inside a groove22420 within the handle assembly 22000. Referring to FIG. 737 , thehandle assembly 22000 comprises a first motor 22062 and a second motor22066 which are configured to power certain functions of the surgicalinstrument system as discussed above. Referring to FIG. 739 for example,the first motor 22062 is configured to power right and left articulationof the end effector, for example. The second motor 22066 is configuredto power the jaw drive of the shaft assembly 20000. When the handleassembly 22000 is in use, the rotation of the end effector is performedmanually by the clinician. The handle assembly 22000 further comprises afirst speed reduction gear box 22064 and a second speed reduction gearbox 22068 disposed within the handle assembly 22000. Still referring toFIG. 737 , the insertable power module 22020 comprises at least twobattery cells 22040 and 22050.

Referring to FIG. 740 , the first handle assembly 21000 comprises apencil grip configured for use with a smoke evacuation tube 21400. Thesmoke evacuation tube 21400 is configured to fit inside a groove 21420within the handle assembly 21000. The shaft assembly 20000 furthercomprises a smoke evacuation tube 20410 which fits over the shaft 20400.Referring to FIG. 741 , the handle assembly 21000 comprises a motor21062 which is configured to power the right and left articulation ofthe end effector. When the handle assembly 21000 is in use, the rotationof the end effector is performed manually by the clinician, and certainfunctions such as a first actuation motion and a second actuation motionof the end effector are locked out as seen in FIG. 743 . The handleassembly 21000 further comprises a speed reduction gear box 21064disposed within the handle assembly 21000. Still referring to FIG. 741 ,the insertable power module 21020 comprises at least two battery cells21040 and 21050.

Referring to FIG. 746 , various surgical instrument systems describedherein comprise one or more feedback systems which are configured toalert the clinician as to the state of the surgical instrument system.The surgical instrument system comprises a handle assembly 26000 whichincludes a first drive 26100, a second drive 26200, and a third drive26300 which are configured to permit drive systems within the handleassembly 26000 to be operably coupled to the drive systems of a shaftassembly 27000. The shaft assembly 27000 is similar to the shaftassembly 20000 in many respects. The handle assembly 26000 furthercomprises a plurality of electrical contacts 26022 configured to placethe handle assembly 26000 in electrical communication with the shaftassembly 27000. The shaft assembly 27000 comprises an actuation rod27700 extending within a shaft 27770, wherein the actuation rod 27700 isdrivable by a drive system of the handle assembly 26000. The shaftassembly 27000 further comprises an end effector 27200 rotatablyattached to the shaft 27770 about an articulation joint 27300. The endeffector 27200 comprises a first jaw 27220 and a second jaw 27222 whichare movable between open and closed positions in response to the motionsof the actuation rod 27700. The handle assembly 26000 further comprisesa curved trigger 26400 rotatably connected to the handle assembly 26000which, as described in greater detail below, is used to control thedrive system. The curved trigger 26400 comprises a curved trigger rod26500 extending therefrom, as also discussed in greater detail below.

Referring to FIG. 751 , further to the above, the handle assembly 26000comprises a motor control system 26010 which is configured to run amotor 26030 configured to drive the drive system of the shaft assembly27000 as mentioned above. The handle assembly 26000 further comprises apower module 26028 configured to supply power to the motor 26030 at thedirection of a motor control system 26010. The handle assembly 26000comprises a trigger sensor 26800 which is in communication with themotor control system 26010 and is configured to monitor the motion ofthe trigger 26400. The trigger sensor 26800 is configured to generate avoltage potential which is detectable by the motor control system26010—the magnitude of which can be used to ascertain the actuationand/or position of the trigger 26400. In response to the signal from thetrigger sensor 26800, the motor control system 26010 is configured torun the motor 26030 to drive the drive rod 26050. In various instances,the trigger sensor 26800 comprises a variable resistance sensor, forexample, and the speed of the motor 26030 is responsive to the signalprovided by the trigger sensor 26800.

As the drive rod 26050 is driven distally by the motor 26030, the driverod 26050 experiences a force load. There is a wide range of acceptableforce loads that the drive rod 26050 may experience during use. Thatsaid, such force loads can suggest certain information about theperformance of the surgical system. For instance, force loads toward thetop of the acceptable range can indicate that thick and/or dense tissueis captured within the end effector 27200 while force loads toward thebottom of the acceptable range can indicate that thin and/or less densetissue is captured within the end effector 27200, for example. Withoutmore, this information is not conveyed to the clinician as the trigger26400 is not mechanically coupled to the drive rod 26050; rather, thetrigger 26400 is electrically coupled to the motor 26030 via the motorcontrol system 26010. Without this information, a clinician may notfully appreciate what is occurring within the surgical system. To thisend, the surgical instrument system comprises means for detecting theforce load experienced by the drive rod 26050 and communicating thisinformation to the clinician. In at least one instance, the surgicalinstrument system comprises one or more load cells and/or strain gaugesconfigured to detect the force load within the drive rod 26050. Inaddition to or in lieu of these mechanical detection systems, the motorcontrol system 26010 is configured to monitor the current drawn by theelectric motor 26030 during use and this information as a proxy for theforce load being experienced by the drive rod 26050. Referring to FIG.751 , the handle assembly comprises a current sensor 26012 incommunication with the power control system 26020, and/or the motorcontrol system 26010, which is configured to monitor the amount ofcurrent drawn by the motor 26030. Discussed below are systems which canrestore the clinician's sense for the loads being experienced within thedrive system based on the load data supplied to the power control system26020.

Referring to FIGS. 747 and 748 , the handle assembly 26000 furthercomprises an electroactive polymer (hereinafter “EAP”) 26600 positionedwithin an aperture defined therein. The EAP 26600 is in signalcommunication with the power control system 26020 and is responsive to avoltage output provided by the power control system 26020. Referringprimarily to FIG. 748 , the handle assembly 26000 comprises a curvedcylinder 26900 which surrounds a portion of the curved trigger rod 26500of the trigger 26400. More specifically, the curved trigger rod 26500comprises a trigger bar 26550 extending through the curved cylinder26900 positioned within the handle assembly 26000. The EAP 26600 isradially constrained by the sidewalls of the curved aperture defined inthe handle 26000. The EAP 26600 reacts to the voltage potential appliedthereto by the power control system 26020 and expands and contractsproportionately in size to the magnitude of the force being applied tothe drive rod 26050. When the voltage applied to the EAP 26600 isincreased, the walls of the handle assembly 26000 prevent the EAP 26600from expanding. As a result, the EAP 26600 expands toward the triggerbar 26550 extending from the curved trigger 26500 and, thus, applies acompressive force to the trigger bar 26550. The compression forceapplied by the EAP 26600 on the trigger bar 26550 compresses the triggerbar 26550 which, in turn, creates a drag force between the EAP 26600 andthe trigger bar 26550 when the trigger bar 26550 is moved by the trigger26400. This drag force is felt by the clinician pulling the trigger26400 and directly communicates the forces of the end effector 27200 tothe clinician. As the magnitude of the load force experienced by thedrive rod 26050 increases, the voltage applied to the EAP 26600 by thepower control system 26020 increases, and the drag experienced by thetrigger 26400 also increases. As the magnitude of the load forceexperienced by the drive rod 26050 decreases, the voltage applied to theEAP 26600 by the power control system 26020 decreases, and the dragexperienced by the trigger 26400 also decreases. These relationships arelinearly proportional; however, any proportional relationship could beused. Moreover, further to the above, the magnitude of the voltagepotential applied to the EAP 26600 by the power control system 26020 isproportionately coupled to the motor current drawn by the motor 26030,the voltage supplied by the load cell circuit, and/or the voltagesupplied by the strain gauge circuit, for example.

Turning to FIG. 749 , the EAP 26600 is shown in a non-energized statebefore the voltage potential is applied to the EAP 26600. As seen inFIG. 749 , there is space defined between the EAP 26600 within thecurved cylinder 26900 and the curved trigger 26500. Referring to FIG.750 , as the voltage potential is applied to the EAP 26600, the EAP26600 constricts the trigger bar 26550 of the curved trigger 26500 whichcreates the drag force discussed above. The relationship between theforces on the end effector 27200 and/or the shaft 27770 and thecompressive force on the curved trigger 26500 is further illustrated inFIGS. 752 and 753 .

Referring to FIG. 752 , L₁ illustrates the torque experienced by themotor drive shaft. L₂ illustrates the load force experienced by thedrive rod 26050. L₃ illustrates the voltage applied to the EAP 26600.The load force on the drive rod 26050 and the torque on the motor driveshaft are proportional to the amount of voltage applied to the EAP26600. That is, as the load force and torque increase, as illustrated byway of L₁ and L₂ in FIG. 752 , the voltage applied to the EAP 26600 alsoincreases. Further to the above, there is a proportional relationshipbetween the compressive force applied to the trigger 26500 and thevoltage applied to the EAP 26600. As the voltage applied to the EAP26600 increases, the drag force on the trigger 26500 increases, asdiscussed in greater detail above. The voltage applied to the EAP 26600increases as a reaction to the amount of current flowing through themotor 26030 which is an indicator of the forces on the drive rod 26050and the torques on the motor drive shaft. Referring to FIG. 753 , L₄illustrates the change in the voltage potential applied to the EAP 26600over time.

Turning to FIG. 761 , additional feedback systems similar to those areconfigured for use with suturing devices. In particular, varioussurgical instrument systems are equipped with programs which are capableof measuring bending and axial loads applied to a suturing device shaftsuch as the shaft 28100 of the suturing device 28000 illustrated in FIG.761 . The suturing device 28000 comprises at least one motor configuredto provide power to the suturing device during a surgical procedure. Thesuturing device 28000 further comprises a distal head 28300 rotatablyconnected to the shaft 28100 by an articulation joint 28200. The handleof the suturing device 28000 comprises a display which is configured toindicate a predefined proportion of loads to a user. The surgicalinstrument systems described herein are also configured for use withrobotic surgical systems as well as cloud-based technology. Variousapplications disclosed which are incorporated by reference disclosesituational awareness of an interactive HUB system which is configuredto define various surgical steps. The devices, systems, and methodsdisclosed in the Subject Application can also be used with the devices,systems, and methods disclosed in U.S. Provisional Patent ApplicationSer. No. 62/659,900, entitled METHOD OF HUB COMMUNICATION, filed on Apr.19, 2018, U.S. Provisional Patent Application Serial No. 62/611,341,entitled INTERACTIVE SURGICAL PLATFORM, filed on Dec. 28, 2017, U.S.Provisional Patent Application Ser. No. 62/611,340, entitled CLOUD-BASEDMEDICAL ANALYTICS, filed on Dec. 28, 2017, and U.S. Provisional PatentApplication Ser. No. 62/611,339, entitled ROBOT ASSISTED SURGICALPLATFORM, filed on Dec. 28, 2017, which are incorporated by reference intheir entireties herein. Such surgical steps include providing thehandle of the suturing device 28000 with and updated ration of theamount of the load being exerted as a portion of the suture stitch orknot tension. The tension is used by the user to create morestandardization of the stitch to stitch tightness. Further uses arecontemplated which include instructional uses for new users of thesurgical instrument systems described herein. FIG. 762 furtherillustrates the relationship between the forces applied to the shaft28100 and the distal head 28300 based on the different motors (e.g. themotor supplying power to perform an actuation motion of an end effectorand the motor supplying power to perform a distal head rotation motion).

The surgical instrument systems discussed in greater detail above areconfigured for use with locking and safety mechanisms. The lockingmechanisms comprise electrical sensing means configured to detectwhether a modular attachment is in a usable or unusable state. Thelocking mechanisms further comprise electrical sensing means configuredto detect whether a loadable mechanism is in a usable or unusable state.FIG. 754 illustrates an exemplary shaft assembly 30000 which is similarto the shaft assembly 20000. The locking mechanisms which will bediscussed in greater detail below are configured for use with any of thesurgical instrument systems described herein. The shaft assembly 30000comprises a drive 30100, a second drive 30200, and a third drive 30300.The shaft assembly 30000 comprises a plurality of electrical contacts30022 configured to place the shaft assembly 30000 in electricalcommunication with any of the handle assemblies described herein uponbeing attached thereto. The shaft assembly 30000 further comprises anon-board control circuit 30500. One example of a single use lockout30400 is illustrated in FIG. 755 . The single use lockout comprises alock solenoid 30410, a lock spring 30420, and a lock pin 30430 as seenin FIGS. 756 and 757 . The lock solenoid 30410 is energized upon powerbeing supplied to the shaft assembly 30000.

In such instances, the lock solenoid 30410 is configured to push thelock pin 30430 outwardly into a locked position; however the lock pin30430 is held in a staged position until the shaft assembly 30000 isdetached from the handle. At such point, the lock spring 30420 can pushthe lock pin 30430 from its staged position into its locked position. Invarious instances, the shaft assembly 30000 comprises a lock shoulder30440 configured to hold the lock pin 30430 in its locked position andprevent the lock pin 30430 from being reset. In such instances, the lockpin 30430 protrudes proximally from the housing of the shaft assembly30000 which prevents the shaft assembly 30000 from being reattached to ahandle. While the solenoid 30410 can drive the lock pin 30430 into itslocked position in certain instances; in other instances, the solenoid30410 holds the lock pin 30430 in its unlocked position until energizedby the attachment of the shaft assembly 30000 to the handle wherein, atsuch point, the solenoid 30410 can release the lock pin 30430 such thatthe lock spring 30420 can move the lock pin 30430 into its stagedposition where the shaft assembly 30000 is attached to the handle andinto its locked position once the shaft assembly 30000 is removed fromthe handle.

Other lockout mechanisms comprise a locking member which immobilizes adrive shaft of a surgical instrument if a modular shaft is attached toan incompatible handle can be used. For example, when a scissor griphandle is attached to an articulating clip applier shaft with distalhead rotation, a lockout prevents distal head rotation drive because thescissor grip handle is used for only one drive system which is often theclip drive. In various instances, the lockout fixes the rotation of thedistal head by engaging a lockout member into the drive shaft at theproximal end of the shaft. An additional locking mechanism for use withthe surgical instrument systems described herein comprises a distallocking mechanism which prevents actuation motions of a clip applier orsuturing device if a loaded cartridge is not in the jaws. A similarlockout mechanism comprises a distal locking mechanism which preventsactuation motions of a clip applier or suturing device if a spentcartridge is positioned in the jaws. The distal locking mechanismfurther comprises a means for sensing the engagement state of the distallockout through a power system of the surgical instrument in order toprevent the activation of the motor or to instruct the motor to providehaptic vibration feedback that the handle assembly is incompatible withthe attachment portion. Additional lockout assemblies include a modularlockout which prohibits or changes the operation of the motor if theshaft is detected to be in an unusable state.

Turning now to FIG. 763 , an exemplary system for identifying thecomponents of a surgical instrument system is disclosed. Step 32100comprises attaching a shaft module to a handle assembly. Step 32200comprises attaching a battery to a handle assembly. Step 32300 comprisesenergizing a safety circuit or watchdog processor wherein either iscompatible with surgical instrument systems discussed in greater detailabove. Decision 32400 comprises the verification of the integrity of theelectrical circuit within the surgical instrument system. If theintegrity of the circuit is bad, then the system is configured todisplay an error signal and shut down in step 32410. If the integrity ofthe circuit is good, the system is configured to identify and log aserial number associated with a handle assembly, battery, and/or shaftassembly, as illustrated in step 32420. Decision 32500 is configured toidentify the type of handle assembly. For example, if the handleassembly is a simple scissors handle, the system is configured tocontrol a program for a simple mechanism configuration which includes ashaft rotation lockout, as illustrated in step 32500. If the systemdetermines that the handle assembly is not a simple scissors handle,then the system is configured to verify the functionality of allinstrument mechanisms as illustrated in step 32510.

With further reference to FIG. 763 , once the system identifies the typeof handle assembly, the system is configured to determine whether theshaft assembly comprises a loadable portion in decision 32600, and isfurther configured to determine the status of the loadable portion. Ifthe loadable portion is unloaded, the system is configured to generatean error message in step 32610 which indicates that the system iswaiting for the loadable portion to be reloaded before a surgicalprocedure can continue. If the loadable portion is loaded, the system isconfigured detect whether a display unit is present during decision32700. If the surgical instrument does not comprise a display unit, forexample, the system is configured use a simple green light to indicatethat the surgical instrument is ready for use. If the surgicalinstrument comprises a display unit, for example, the system configuresthe display unit for use with whatever shaft assembly is attached to thesurgical instrument in step 32720. Additional systems comprise theidentification of various compatible shaft assemblies and handleassemblies. Other systems comprise the identification of the status of apower module and the status of the power module. The verificationprocesses described above are configured for use with any of thesurgical instrument systems described herein. The surgical instruments,modules, systems, and methods disclosed herein can be used with thevarious disclosures incorporated by reference. The devices, systems, andmethods disclosed in the Subject Application can also be used with thedevices, systems, and methods disclosed in U.S. Provisional PatentApplication Ser. No. 62/659,900, entitled METHOD OF HUB COMMUNICATION,filed on Apr. 19, 2018, U.S. Provisional Patent Application Ser. No.62/611,341, entitled INTERACTIVE SURGICAL PLATFORM, filed on Dec. 28,2017, U.S. Provisional Patent Application Ser. No. 62/611,340, entitledCLOUD-BASED MEDICAL ANALYTICS, filed on Dec. 28, 2017, and U.S.Provisional Patent Application Ser. No. 62/611,339, entitled ROBOTASSISTED SURGICAL PLATFORM, filed on Dec. 28, 2017, which areincorporated by reference in their entireties herein.

A surgical system 120000 is illustrated in FIGS. 764 and 765 . Thesurgical system 120000 comprises a handle, a shaft assembly 120020extending from the handle, and an end effector releasably attachable tothe shaft assembly 120020. The shaft assembly 120020 comprises anelongate shaft 120021 including a distal end 120022 and a longitudinalaperture 120023 extending therethrough. The shaft assembly 120020further comprises a drive member movably positioned in the longitudinalaperture 120023 which is movable longitudinally by a drive system in thehandle. The end effector comprises a frame that is mounted to a frame ofthe elongate shaft 120021 when the end effector is attached to the shaftassembly 120020. The end effector further comprises a drive member thatis operably connected to the drive member of the shaft assembly 120020when the end effector is attached to the shaft assembly 120020. Thedistal end of the shaft drive member comprises a cradle, or connector,configured to receive the proximal end of the end effector drive member.The cradle is configured to constrain the relative movement between theshaft drive member and the end effector drive member except for thedirection, or degree of freedom, in which the end effector drive memberwas attached to the shaft drive member. In at least one instance, theshaft drive member comprises a longitudinal axis and the end effectordrive member is loaded into the cradle in a direction which istransverse to the longitudinal axis.

Further to the above, referring again to FIGS. 764 and 765 , the shaftassembly 120020 further comprises a lock configured to constrain thedegree of freedom in the loading direction between the shaft drivemember and the end effector drive member. In at least one instance, theshaft assembly 120020 comprises a lock 120024 which is slidlongitudinally to constrain the movement of the end effector drivemember such that it cannot be detached from the shaft drive member. Thelock 120024 is slid distally to lock the drive members together andproximally to unlock the drive members so that the drive members can bedetached. In various instances, the handle comprises a control which,when actuated, can cause the control system of the surgical system120000 to lock or unlock the lock 120024. The lock 120024 is not biasedinto either its locked or unlocked position; however, alternativeembodiments are envisioned in which the lock 120024 is biased into itslocked position. In such embodiments, the shaft assembly 120020comprises a biasing member, such as a spring, for example, configured topush the lock 120024 distally toward its locked position. That said, thebiasing member can be overcome by the clinician and/or by an actuator,such as a solenoid, for example, which pushes the lock 120024 proximallyto unlock the coupling between the shaft drive member and the endeffector drive member. In either event, the shaft assembly 120020 cancomprise a release mechanism at the distal end thereof, i.e., at theinterconnection between the shaft assembly 120020 and the end effector,which can unlock the lock 120024. In addition to or in lieu of theabove, the handle can comprise a release mechanism which can unlock thelock 120024.

A surgical system 120100 is illustrated in FIG. 766 . The surgicalsystem 120100 comprises a handle, a shaft assembly 120120 extending fromthe handle, and an end effector 120130 releasably attachable to theshaft assembly 120120. The shaft assembly 120120 comprises an elongateshaft 120121 including a distal end 120122. The shaft assembly 120120further comprises a first rotatable drive shaft 120140 driven by a firstelectric motor, a second rotatable drive shaft 120150 driven by a secondelectric motor, and a third rotatable drive shaft 120160 driven by athird electric motor. The first, second, and third electric motors arepositioned in the shaft assembly 120120 and/or the handle. The endeffector 120130 comprises an elongate shaft 120131 attachable to theelongate shaft 120121 of the shaft assembly 120120. The end effector120130 includes a first drive shaft 120130′ operably couplable to thefirst drive shaft 120130, a second drive shaft 120140′ operablycouplable to the second drive shaft 120140, and a third drive shaft120160′ operably couplable to the third drive shaft 120160 when the endeffector 120130 is assembled to the shaft assembly 120120.

Further to the above, the shaft assembly 120120 and the end effector120130 comprise co-operating features which properly align the threesets of drive shafts when the end effector 120130 is assembled to theshaft assembly 120120. For instance, the shaft assembly 120120 comprisesalignment pins 120125 which are configured to be received withinalignment slots 120135 defined in the end effector shaft 120131 whichare configured to lock the end effector 120130 to the shaft assembly120120 as the end effector 120130 is rotated relative to the shaftassembly 120120. In various instances, such a connection can comprise abayonet connection. In addition to or in lieu of these alignmentfeatures, the shaft assembly 120120 and the end effector 120130 cancomprise magnetic alignment features which align the end effector 120130relative to the shaft assembly 120120. The distal end 120122 of theshaft assembly 120120 comprises a first group of permanent magnets120123 and a second group of permanent magnets 120124 embedded therein.The permanent magnets 120123 have positive poles facing distally and thesecond permanent magnets 120124 have negative poles facing distally.Similarly, the proximal end 120132 of the end effector shaft 120131comprises a first group of permanent magnets 120133 and a second groupof permanent magnets 120134 embedded therein. The first permanentmagnets 120133 have positive poles facing proximally and the secondpermanent magnets 120134 have negative poles facing proximally. When theproximal end 120132 of the end effector 120130 is brought into proximitywith the distal end 120122 of the shaft assembly 120120, the magnetsprevent the end effector 120130 from being attached from the shaftassembly 120120 in a misaligned manner.

In various instances, further to the above, a first handle comprisesthree electric motors to drive the first, second, and third drive shafts120140, 120150, and 120160. In at least one instance, the first driveshaft 120140 of the shaft assembly 120120 articulates the distal end ofthe end effector 120130 about an articulation joint, the second driveshaft 120150 of the shaft assembly 120120 opens and closes the jaws ofthe end effector 120130, and the third drive shaft 120160 rotates thedistal end of the end effector 120130 about a longitudinal axis. Thatsaid, other handles can comprise less than three electric motors and donot drive all of the first, second, and third drive shafts 120140,120150, and 120160. In at least one such instance, a second handlecomprises two electric motors which drive two of the shaft assemblydrive shafts. The second handle is configured such that the shaftassembly 120120 is attached to the second handle in a manner in whichthe first drive shaft 120140 and the second drive shaft 120150 of theshaft assembly 120120 are operably coupled with the electric motors ofthe second handle. The third drive shaft 120160 is not operably coupledwith an electric motor in such instances. As a result, the rotation ofthe distal end of the end effector 120130 would have to be performedmanually by the clinician by rotating the entire surgical system 120100about the longitudinal axis. In at least one instance, the first handlecomprises a pistol grip configuration and the second handle comprises ascissors grip configuration. A third handle may have only one electricmotor for driving only one of the shaft assembly drives. In at least onesuch instance, the third handle comprises a pencil grip configurationand the shaft assembly 120120 is attached to the third handle in amanner in which the first drive shaft 120140, the articulation driveshaft, is operably coupled to the only drive motor. Other arrangementsare possible.

A surgical system 120200 is illustrated in FIG. 767 . The surgicalsystem 120200 comprises a handle 120210 and a shaft assembly 120220attached to the handle 120210. The shaft assembly 120220 comprises aframe 120221 and four rotatable drive shafts—a first drive shaft 120240,a second drive shaft 120250, a third drive shaft 120260, and a fourthdrive shaft 120270. The four drive shafts are rotatable independently ofone another to perform different functions of the surgical system120200. The handle 120210 comprises an electric motor 120212 comprisinga rotatable output and a rotatable drive shaft 120215 which are operablyconnected by a gear train 120214. The rotatable drive shaft 120215 isselectively engageable with the four drive shafts of the shaft assembly120220 to selectively drive one of the four drive shafts at a time. Thehandle 120210 further comprises a rotatable shifter 120216 configured toplace the drive shaft 120215 in one of four distinct and discrete drivepositions in which the drive shaft 120215 is operably engaged with oneof the four drive shafts 120240, 120250, 120260, and 120270. Therotatable shifter 120216 comprises a throughhole 120217 defined thereinthrough which the drive shaft 120215 extends. The throughhole 120217comprises sidewalls configured to push the drive shaft 120215 betweenthe four drive positions when the shifter 120216 is rotated. The shifter120216 comprises a lever, or protrusion, 120218 extending therefromwhich a clinician can use to rotate the shifter 120216. That said, thehandle 120210 can comprise an electric motor and actuator for shiftingthe shifter 120216 between its four drive positions.

Further to the above, the shifting system of the handle 120210 comprisesa frame, or shift block, 120211 configured to releasably hold the driveshaft 120215 in its four drive positions. The shift block 120211comprises four drive slots 120213 defined therein which correspond tothe four drive positions of the drive shaft 120215. The sidewalls ofeach drive slot 120213 are configured to prevent, or at least inhibit,lateral movement and/or deflection of the drive shaft 120215 until thedrive shaft 120215 is moved into a different position by the shifter120216. In various instances, the sidewalls of two adjacent drive slots120213 form a peak 120219 therebetween which prevents, or at leastinhibits, the drive shaft 120215 from unintentionally hopping out of adrive slot 120213. As a result of the four peaks 120219 distinctlydefining the four drive positions of the drive shaft 120215, the shiftblock 120211 comprises a quad-stable compliant system. The apex of eachpeak 120219 is rounded such that the drive shaft 120215 does not getstuck intermediate one of the four stable drive positions, or driveslots 120213. The reader should appreciate that the drive shaft 120215may flex inwardly when moving between drive slots 120213 and that theresilient inward bending of the drive shaft 120215 stores energy in thedrive shaft 120215 which seeks to reactively seat the drive shaft 120215in the nearest drive slot 120213.

A surgical system 120300 is depicted in FIGS. 768-771 . The surgicalsystem 120300 is similar to the surgical system 120200 in many respects.Referring primarily to FIG. 769 , the shift block 120311 of the surgicalsystem 120300 comprises peaks 120319 positioned intermediate drive slots120313. The peaks 120219 of the shift block 120211 are comprised ofsolid material while each of the peaks 120319 of the shift block 120311is comprised of a leaf spring. Similar to the above, the leaf springs ofthe peaks 120319 prevent, or at least inhibit, the unintentionalshifting of the drive shaft out of a drive slot 120313. Referringprimarily to FIG. 770 , the leaf springs are configured to deflect asthe drive shaft is being shifted between drive positions, or driveslots, 120313 and then resiliently return to their undeflectedconfigurations once the drive shaft has passed thereby. This resiliencyof the leaf springs also prevents, or inhibits, the drive shaft frombecoming stuck in an intermediate, or unstable, position as the leafsprings act to resiliently undeflect and push the drive shaft into oneof the drive slots 120313. The four stable positions of the shift blocks120211 and 120311 are 90 degrees, or approximately 90 degrees, apart.That said, a shaft assembly having three drive shafts has three drivepositions and a corresponding shift block comprises three drive slotsspaced 120 degrees, or approximately 120 degrees, apart. In any event, ashaft assembly can comprise any suitable number of drive shafts and thecorresponding shift block can comprise a corresponding number of driveslots that are evenly spaced apart.

A surgical system 120500 is depicted in FIGS. 776 and 777 . The surgicalsystem 120500 comprises a handle, a shaft 120520 extending from thehandle, and an end effector extending from the shaft 120520. The handlecomprises a single rotatable drive shaft 120510 configured toselectively drive a first drive shaft 120540, a second drive shaft120550, and a third drive shaft 120560 via a shiftable transmission120590. The drive shaft 120510 comprises a pinion gear 120515 mounted tothe distal end thereof which is operably engaged with a transmissionshaft 120595 such that the rotation of the drive shaft 120510 istransferred to the transmission shaft 120595. The transmission shaft120595 is shiftable between three drive positions—a first drive positionin which the transmission shaft 120595 is operably engaged with thefirst drive shaft 120540 (FIG. 776 ), a second drive position in whichthe transmission shaft 120595 is operably engaged with the second driveshaft 120550 (FIG. 777 ), and a third drive position in which thetransmission shaft 120595 is operably engaged with the third drive shaft120560. The transmission 120590 is rotated between its first, second,and third drive positions by a rotatable shifter 120580. The shifter120580 comprises a shift arm 120585 fixedly mounted thereto whichcomprises a bearing aperture defined therein—the sidewalls of whichrotatably support the transmission shaft 120595 when the transmissionshaft 120595 is operably engaged with one of the three drive shafts120540, 120550, and 120560. The three drive positions comprise a middle,or top-dead-center, position in which the transmission shaft 120595 isengaged with the first drive shaft 120540 (FIG. 776 ), a lateralposition approximately 120 degrees to one side of the top-dead-centerposition in which the transmission shaft 120595 is engaged with thesecond drive shaft 120550 (FIG. 777 ), and another lateral positionapproximately 120 degrees to the other side of the top-dead-centerposition in which the transmission shaft 120595 is engaged with thethird drive shaft 120560.

A surgical system 120400 is depicted in FIGS. 772-775 . The surgicalsystem 120400 comprises a handle, a shaft 120420 extending from thehandle, and an end effector 120430 connected to the shaft 120420 aboutan articulation joint. The handle comprises a rotatable input shaft120410 shiftable longitudinally between a distal position (FIGS. 774 and775 ) in which the input shaft 120410 is operably engaged with anarticulation drive shaft 120440 and a proximal position (FIGS. 772 and773 ) in which the input shaft 120410 is operably engaged with a jawdrive shaft 120450. The input shaft 120410 comprises a pinion gear120415 defined on the distal thereof that is operably meshed with apinion gear 120445 defined on the articulation drive shaft 120440 whenthe input shaft 120140 is in its distal position and operably meshedwithin a pinion gear 120455 defined on the jaw drive shaft 120450 whenthe input shaft 120140 is in its proximal position. The articulationdrive shaft 120440 comprises a bevel gear fixedly mounted thereto whichis operably meshed with a bevel gear fixedly mounted to a frame 120431of the end effector 120430 such that, when the input shaft 120410 isoperably engaged with the articulation drive shaft 120440 and thearticulation drive shaft 120440 is rotated in a first direction, the endeffector 120430 is articulated in a first direction. Similarly, thearticulation drive shaft 120440 is rotated in a second, or opposite,direction, to articulate the end effector 120430 in a second, oropposite, direction.

The jaw drive shaft 120450 comprises a threaded distal end which isthreadably engaged with a drive nut 120435 which is translated distallywhen the jaw drive shaft 120450 is rotated in a first direction andtranslated proximally when the jaw drive shaft 120450 is rotated in asecond, or opposite, direction. The end effector 120430 furthercomprises a first jaw 120432 and a second jaw 120434 pivotably coupledto one another and pivotably coupled to the drive nut 120435 such thatthe jaws 120432 and 120434 are opened when the drive nut 120435 ispushed distally and closed when the drive nut 120435 is pulledproximally. Notably, the entire drive shaft 120450 is depicted in FIGS.772-774 , but not in FIG. 775 . The drive shaft 120450 has beentruncated in FIG. 775 to better show the articulation joint, but thereader should understand that the drive shaft 120450 bends toaccommodate the articulation motion. Other embodiments are envisioned inwhich the drive shaft 120450 comprises at least one universal joint, forexample, to accommodate the articulation motion.

As described above, referring again to FIGS. 772-775 , the input shaft120410 is translatable to selectively engage the articulation drivesystem and the jaw drive system and then rotatable to drive the systemthat it is engaged with. That said, the input shaft 120410 may not beable to drive, or at least properly drive, the articulation drive systemor the jaw drive system if the input shaft 120410 is in a positionintermediate the proximal drive position and the distal drive position.To this end, the surgical system 120400 comprises a biasing memberconfigured to push the input shaft 120410 into its distal position inwhich the input shaft 120410 is operably engaged with the articulationdrive system. In order to move the input shaft 120410 into its proximalposition, an electric actuator must overcome this biasing force.Alternatively, the biasing member is configured to push the input shaft120410 into its proximal position in which the input shaft 120410 isoperably engaged with the jaw drive system.

Further to the above, the frame of the shaft 120420 comprises arotatable portion 120431 which permits the jaws 120430 to rotate about alongitudinal shaft axis (FIGS. 772 and 774 ). In various instances, thesurgical system comprises a drive system configured to rotate the jaws120430 about the longitudinal axis.

In various instances, an input shaft is shiftable between two or morepositions to drive two or more functions of a surgical system. Asurgical system 120600 is depicted in FIG. 778 which comprises a handle,a shaft assembly 120620 extending from the handle, and an end effector120630 extending from the shaft assembly 120620. The end effector 120630is rotatably coupled to the shaft assembly 120620 about a rotation joint120690 configured to permit the end effector 120630 to be rotated abouta longitudinal axis. The surgical system 120600 further comprises a jawdrive shaft 120650 configured to open and close the jaws of the endeffector 120630 and, also, a rotation drive shaft 120660 configured torotate the end effector 120630 about the longitudinal shaft axis. Therotation drive shaft 120660 comprises a pinion gear 120661 mounted tothe distal end thereof which is operably intermeshed with a ring of gearteeth defined in the interior of the end effector housing 120631 suchthat the rotation of the rotation drive shaft 120660 is transferred tothe end effector 120630. Similar to the above, the handle comprises aninput shaft which is shiftable between a first position in which theinput shaft is operably coupled to the jaw drive shaft 120650 and asecond position in which the input shaft is operably coupled to therotation drive shaft 120660. Also, similar to the above, the input shaftcan be biased into the first or second position by a biasing member. Inat least one embodiment, the input drive is shiftable into a thirdposition to engage an articulation drive shaft of an articulation drivesystem.

A surgical system 120700 is depicted in FIGS. 779-782 . The surgicalsystem 120700 comprises a handle, a shaft assembly 120720 extending fromthe handle, and an end effector releasably attachable to the shaftassembly 120720. Similar to the above, the end effector comprises firstand second jaws that are movable between open and closed positions. Thesurgical system 120700 further comprises an articulation joint 120780about which the end effector can be rotated relative to the shaftassembly 120720. Moreover, the surgical system 120700 further comprisesa rotation joint 120790 which permits the end effector to be rotatedrelative to the shaft assembly 120720 about a longitudinal end effectoraxis. As described in greater detail below, the surgical system 120700comprises a first drive system 120740 to rotate the shaft assembly120720 about a longitudinal shaft axis and articulate the end effectorand, also, a second drive system 120750 to rotate the end effectorrelative to the shaft assembly 120720 about the longitudinal endeffector axis and drive the jaws between their open and closedpositions.

The first drive system 120740 of the surgical system 120700 comprises anelectric actuator 120742 and an input shaft 120744. The electricactuator 120742 is configured to rotate and translate the input shaft120744. The input shaft 120744 comprises a spur gear 120745 fixedlymounted to the distal end thereof such that the spur gear 120745 rotatesand translates with the input shaft 120744. The spur gear 120745 isoperably meshed with a spur gear 120747 fixedly mounted to anarticulation actuator 120741 which is keyed (FIG. 780 ) to a shafthousing 120748 such that the rotation of the input shaft 120744 istransferred to the shaft housing 120748. The shaft housing 120748 issufficiently coupled to the frame of the shaft assembly 120720 suchthat, when the electric actuator 120742 rotates the input shaft 120744,the input shaft 120744 rotates the shaft assembly 120720. Notably, thearticulation actuator 120741 comprises a proximal flange 120746positioned proximally with respect to the spur gear 120747 and a distalflange 120749 positioned distally with respect to the spur gear 120747.The proximal flange 120746 and the distal flange 120749 are configuredto prevent the spur gears 120745 and 120747 from translating andbecoming operably demeshed from one another. Moreover, the proximalflange 120746 and the distal flange 120749 are configured to be drivenproximally and distally by the spur gear 120745 as discussed in greaterdetail below.

Further to the above, the electric actuator 120742 is configured totranslate the drive shaft 120744 proximally and distally to articulatethe end effector about the articulation joint 120780. When the driveshaft 120744 is pushed distally by the electric actuator 120742, thespur gear 120745 pushes distally on the distal flange 120749 extendingfrom the articulation actuator 120741. Correspondingly, the spur gear120745 pulls proximally on the proximal flange 120746 extending from thearticulation actuator 120741 when the drive shaft 120744 is pulledproximally by the electric actuator 120742. The articulation actuator120741 is coupled to a distal end 120722 of the shaft assembly 120720such that the distal translation of the articulation actuator 120741articulates the distal shaft end 120722, and the end effector mountedthereto, in a first direction and such that the proximal translation ofthe articulation actuator 120741 articulates the distal shaft end 120722and the end effector in a second, or opposite, direction.

The second drive system 120750 of the surgical system 120700 comprisesan electric actuator 120752 and a drive shaft 120754. The electricactuator 120752 is configured to rotate and translate the drive shaft120754. Referring primarily to FIG. 781 , a flexible drive shaft 120756is mounted to the drive shaft 120754 such that the flexible drive shaft120756 rotates and translates with the drive shaft 120754. The flexibledrive shaft 120756 comprises a laser-cut steel tube, for example, butcould comprise any suitable configuration. The flexible drive shaft120756 extends through the articulation joint 120780 and at least partof the distal shaft end 120722 and is configured to accommodate thearticulation of the distal shaft end 120722. The flexible drive shaft120756 is coupled to the end effector such that, when the flexible driveshaft 120756 is rotated by the electric actuator 120752, the flexibledrive shaft 120756 rotates the end effector about the rotation joint120790. Moreover, the flexible drive shaft 120756 is coupled to the jawdrive of the end effector such that the longitudinal translation of theflexible drive shaft 120756 opens and closes the jaws of the endeffector.

As discussed above, the surgical system 120700 is configured to drivefour independent motions—end effector rotation, shaft rotation, endeffector articulation, and end effector actuation. These functions canbe performed at the same time and/or at different times. In at least oneinstance, it is beneficial to rotate the end effector and the shaft atthe same time so that their rotation is synchronized. Otherwise, aclinician may be surprised to discover that the end effector is notturning with the shaft when what they wanted in the first place was toreorient the end effector. That said, the end effector can be rotatedindependently of the shaft.

FIG. 782 depicts a longitudinal passage extending through the shaftassembly 120720 which is configured for signal and/or power conductorsto extend there through.

Further to the above, the rotation of the end effector, the actuation ofthe end effector, the rotation of the shaft, and the articulation of theend effector can occur sequentially in any suitable order. That said,referring to FIGS. 794-798 , two or more of these functions can occur atthe same time. A surgical system 124100 is depicted in FIG. 795 . Thesurgical system 124100 comprises a shaft assembly 124120 and an endeffector 124130 rotatably connected to the shaft assembly 124120 aboutan articulation joint 124180. Moreover, the end effector 124130 isrotatable relative to the shaft assembly 124120 about a rotation joint124190. When the surgical system 124100 is attached to a handle having asufficient number of drive systems, referring to FIGS. 795 and 796 , theend effector 124130 can be rotated and articulated at the same time, forexample. Such an arrangement can provide a smooth motion of the endeffector 124130. When the surgical system 124100 is not attached to ahandle having a sufficient number of drive systems, referring to FIGS.797 and 798 , the end effector 124130 would have to be rotated andarticulated sequentially using a shiftable drive.

A surgical system 121000 is illustrated in FIGS. 783-785 . The surgicalsystem 121000 comprises a handle 121010 and a shaft assembly 121020releasably attachable to the handle 121010. The shaft assembly 121020comprises three drive systems and the handle 121010 comprises threedrive outputs, but only two motors to drive the three drive outputs. Oneof the motors in the handle 121010 can be dedicated to driving one ofthe drives of the shaft assembly 121020. The other motor in the handle121010, i.e. motor 121011, is configured to selectively drive the othertwo drives of the shaft assembly 121020. The motor 121011 comprises arotatable output shaft 121012 and an elongate spur gear 121013 fixedlymounted to the output shaft 121012. The output shaft 121012 isselectively couplable with a first drive shaft 121040 and a second driveshaft 121050 by a transmission 121090. The transmission 120190 comprisesa transfer gear 121015 slideably engaged with the elongate gear 121013.The transfer gear 121015 is slideable between a first position in whichthe transfer gear 121015 is operably intermeshed with the elongate spurgear 121013 and a first spur gear 121045 fixedly mounted to the firstdrive shaft 121040 and a second position in which the transfer gear121015 is operably intermeshed with the elongate spur gear 121013 and asecond spur gear 121055 fixedly mounted to the second drive shaft121050. The transmission 121090 further comprises a shifting mechanism121014 configured to move the transfer gear 121015 between its first andsecond positions. Such an arrangement allows the handle 121010 to beused to drive all three drive systems of the shaft assembly 121020,although the drive systems driven by the first drive shaft 121040 andthe second drive shaft 121050 cannot be driven at the same time as thespur gears 121045 and 121055 are separated such that the transfer gear121015 cannot drive spur gears 121045 and 121055 at the same time.

A surgical system 122000 is illustrated in FIGS. 786 and 787 . Thesurgical system 122000 comprises a handle 122010, a handle 122010′, anda shaft assembly 122020 selectively attachable to the handle 122010(FIG. 786 ) and the handle 122010′ (FIG. 787 ). Referring to FIG. 786 ,the handle 122010 comprises two rotatable drive outputs which areoperably coupleable with two drive systems of the shaft assembly 122020.The handle 122010 comprises a first drive output which is operablyengaged with a first rotatable drive shaft 122040 and a second driveoutput which is operably engaged with a second rotatable drive shaft122050 when the shaft assembly 122020 is attached to the handle 122010.The first drive shaft 122040 comprises a longitudinal splined portion122047 and a spur gear 122097 slideably supported on the splined portion122047 such that the rotation of the first drive shaft 122040 istransferred to the spur gear 122097 and, as described in greater detailbelow, the spur gear 122097 is slideable into another, or secondposition, when the shaft assembly 122020 is attached to the handle122010′ instead. While the shaft assembly 122020 is attached to thehandle 122010, however, the spur gear 122097 is in its first positionillustrated in FIG. 786 and is operably intermeshed with a spur gear122067 fixedly mounted to a rotatable drive shaft 122060. In suchinstances, as a result, the rotation of the first drive shaft 122040 istransferred to the drive shaft 122060 which can drive a function of thesurgical system 122000. Also, in such instances, the second drive shaft122050 is rotatable to drive a second function of the surgical system122000 independently of the first drive shaft 122040.

Notably, further to the above, the shaft assembly 122020 furthercomprises a handle detection system 122090 configured to detect whetherthe shaft assembly 122020 is attached to the handle 122010 or the handle122010′. The handle detection system 122090 comprises a switch element122095 extending proximally from the proximal end of the shaft assembly122020. When the shaft assembly 122020 is attached to the handle 122010(FIG. 786 ), the switch element 122095 extends into a clearance aperture122015 defined in the housing of the handle 122010. The switch element122095 is biased proximally by a biasing element, such as a spring, forexample, such that the switch element 122095 does not contact, or close,a switch contact 122094 in the shaft assembly 122020 unless the switchelement 122095 is driven distally—which does not happen when the shaftassembly 122020 is attached to the handle 122010 because of theclearance aperture 122015. When the shaft assembly 122020 is attached tothe handle 122010′ (FIG. 787 ), however, the switch element 122095contacts the housing of the handle 122010′ and is driven distally intoengagement with the switch contact 122094. The closure of the switchelement 122095 actuates a solenoid 122092 of the handle detection system122090 which drives the transfer gear 122097 from its first position(FIG. 786 ) into its second position (FIG. 787 ) via a link arm 122093and a shuttle 122096. When the transfer gear 122097 is in its secondposition, as illustrated in FIG. 787 , the transfer gear 122097 is nolonger operably intermeshed with the spur gear 122067 of the drive shaft122060 and is, instead, operably intermeshed with a spur gear 122057fixedly mounted to the second drive shaft 122050. In such instances, therotation of the first drive shaft 122040 is transferred to the seconddrive shaft 122050 instead of the drive shaft 122060. Such anarrangement allows the second drive shaft 122050 to always be driven bya motor-driven drive regardless of whether the shaft assembly 122020 isattached to the handle 122010, which has a second independently drivableoutput, or the handle 122010′ which does not have a second independentlydrivable output. When the shaft assembly 122020 is detached from thehandle 122010′, the biasing member pushes the switch element 122095distally once again which opens the switch contact 122094. As a result,the solenoid 122092, or a return spring of the solenoid 122092, returnsthe transfer gear 122097 back into its first position. In variousembodiments, the shaft assembly 122020 comprises a power source, such asa battery, for example, configured to operate the solenoid 122092.

FIGS. 788-793 illustrate a surgical system 123000. The surgical system123000 comprises a handle 123010 and a shaft assembly 123020 extendingfrom the handle 123010. The handle 123010 comprises a first driveoutput, a second drive output, and a third drive output. The first driveoutput is manually-driven, which means that it is powered by theclinician's hand to drive a first function of the surgical system123000. In at least one instance, the first drive output rotates theshaft assembly 123020 about a longitudinal axis. The second drive outputis driven by an electric motor and the third drive output is driven byanother electric motor. The second drive output drives a second functionof the surgical system 123000 and the third drive output drives a thirdfunction of the surgical system 123000. In various instances, theoperation of the first drive output can affect the second functionand/or the third function of the surgical system 123000. To this end,the handle 123010 comprises a system configured to monitor themanually-driven first drive system and automatically adjust thecondition of the second and/or third drive system based on the movementof the first drive system. In at least one instance, the handle 123010comprises an encoder, for example, configured to monitor the rotation ofa rotational member of the first drive system. The encoder is in signalcommunication with the control system of the surgical system 123000which is also in signal communication with the electric motors of thesecond and third drive systems. In various instances, the control systemcan operate the electric motors of the second and/or third drive systemswhen the control system detects the motion of the first drive system viathe encoder, for example. In at least one instance, the second drivesystem rotates the end effector, or distal head, of the shaft assembly123020 about a longitudinal axis and, when the shaft assembly 123020 isrotated manually, the control system can operate the electric motor ofthe second drive system to maintain, or at least substantially maintain,the alignment between the distal head and the shaft assembly 123020 whenthe shaft assembly 123020 is rotated.

Referring to FIGS. 788, 789, and 791 , the handle 123010 comprises afirst drive system including a first electric drive motor 123110, asecond drive system including a second electric drive motor 123210, anda third drive system including a third electric drive motor 123310. Thefirst drive system is configured to drive a first function of the shaftassembly 123020. The second drive system is configured to drive a secondfunction of the shaft assembly 123020, and the third drive system isconfigured to drive a third function of the shaft assembly 123020. Thefirst electric drive motor 123110 comprises a rotatable drive shaft123120 and an output gear 123130 fixedly mounted to the drive shaft123120. The output gear 123130 is meshingly engaged with a ring of gearteeth surrounding a tubular drive shaft 123140 of the first drive systemsuch that the drive shaft 123140 is rotated when the output gear 123130is rotated by the electric drive motor 123110. The drive shaft 123140 isoperably coupled, via a geared transmission (not shown), with a threadedoutput shaft 123150 rotatably supported in the shaft assembly 123030.The first drive system further comprises a drive nut 123160 threadablycoupled to the threaded output shaft 123150 such that, when the threadedoutput shaft 123150 is rotated by the tubular drive shaft 123140, thedrive nut 123160 is driven proximally or distally, depending on thedirection in which the threaded output shaft 123150 is rotated. Thefirst drive system further comprises a drive rod extending from thedrive nut 123160 which, in use, is configured to drive one or more endeffector functions.

The second electric drive motor 123210 comprises a rotatable drive shaft123220 and an output gear 123230 fixedly mounted to the drive shaft123220. The output gear 123230 is meshingly engaged with a ring of gearteeth surrounding a tubular drive shaft 123240 of the second drivesystem such that the drive shaft 123240 is rotated when the output gear123230 is rotated by the electric drive motor 123210. The drive shaft123240 is operably coupled with a spur gear 123250 meshingly engagedwith a ring of gear teeth defined on the drive shaft 123240 such thatthe spur gear 123250 is rotated when the drive shaft 123240 is rotated.The second drive system further comprises a threaded output shaft 123260that is rotatably supported in the shaft assembly 123030 and fixedlymounted to the spur gear 123250. The second drive system furthercomprises a drive nut threadably coupled to the threaded output shaft123260 such that, when the threaded output shaft 123260 is rotated bythe tubular drive shaft 123240, the drive nut is driven proximally ordistally, depending on the direction in which the threaded output shaft123260 is rotated.

The third electric drive motor 123310 comprises a rotatable drive shaft123320 and an output gear 123330 fixedly mounted to the drive shaft123320. The output gear 123330 is meshingly engaged with a ring of gearteeth surrounding a tubular drive shaft 123340 of the third drive systemsuch that the drive shaft 123340 is rotated when the output gear 123330is rotated by the electric drive motor 123310. The drive shaft 123340 isoperably coupled with a spur gear 123350 meshingly engaged with a ringof gear teeth defined on the drive shaft 123340 such that the spur gear123350 is rotated when the drive shaft 123340 is rotated. The seconddrive system further comprises a transfer shaft 123360 that is rotatablysupported in the shaft assembly 123030 and fixedly mounted to the spurgear 123350 and, in addition, another spur gear 123370. The spur gear123370 is operably intermeshed with a threaded output shaft 123380 whichis rotatably supported in the shaft assembly 123020. Similar to theabove, the third drive system further comprises a drive nut threadablycoupled to the threaded output shaft 123380 such that, when the threadedoutput shaft 123380 is rotated by the transfer shaft 123360, the drivenut is driven proximally or distally, depending on the direction inwhich the transfer shaft 123360 is rotated.

A surgical system 123000′ is illustrated in FIGS. 790 and 793 . Thesurgical system 123000′ is similar to the surgical system 123000 in manyrespects. For instance, the surgical system 123000′ comprises threedrive motors, 123110, 123210, and 123310. The first electric drive motor123110 drives a first drive system of a shaft assembly 123020′ includinga rotatable output 123170′. The second electric drive motor 123210drives a second drive system of the shaft assembly 123020′ including atranslatable output 123260′, and the third electric drive motor 123310drives a third drive system of the shaft assembly 123020′ including arotatable output 123380′. Referring to FIG. 790 , the shaft assembly123020 comprises a housing 123040′ and a frame 123030′ which rotatablysupports the rotatable outputs 123170′ and 123380′ and slideablysupports the translatable output 123260′. Having a translatable outputalongside one or more rotatable outputs provides a compact design.

A surgical system 123000″ is illustrated in FIG. 792 . The surgicalsystem 123000″ is similar to the surgical system 123000 in manyrespects. For instance, the surgical system 123000″ comprises threedrive motors, 123110, 123210, and 123310. The first electric drive motor123110 drives a first drive system of a shaft assembly 123020″ includinga first rotatable output 123140″. The second electric drive motor 123210drives a second drive system of the shaft assembly 123020″ including asecond rotatable output 123240″, and the third electric drive motor123310 drives a third drive system of the shaft assembly 123020″including a third rotatable output 123340″. The first rotatable outputs123140″, 123240″, and 123340″ are concentrically nested. Such anarrangement provides a compact design such that the nested outputsprovide bearing support to one another.

A surgical system 124200 is illustrated in FIGS. 799 and 800 . Thesurgical system 124200 comprises a handle, a shaft assembly 124200extending from the handle, and an end effector 124230. The shaftassembly 124220 comprises an input shaft 124210 configured to performtwo functions of the surgical system 124200 at the same time. Morespecifically, the input shaft 124210 is configured to simultaneouslydrive a clip feeding drive 124240 configured to advance a clip 124290into the jaws 124232 of the end effector 124230 during a feeding strokeand a crimping drive 124250 configured to deform the clip 124290 duringa crimping stroke. The input shaft 124210 comprises a first threadedsection 124212 and a second threaded section 124214. The first threadedsection 124212 and the second threaded section 124214 have oppositethreads, i.e., one has left-hand threads and the other has right-handthreads. Referring to FIG. 799 , the clip feeding drive 124240 isthreadably engaged with the second threaded section 124214 of the driveshaft 124210 and is advanced distally to perform the clip feeding strokewhen the drive shaft 124210 is rotated in a first direction. Referringagain to FIG. 799 , the clip crimping drive 124250 is threadably engagedwith the first threaded section 124212 of the drive shaft 124210 and isretracted proximally when the drive shaft 124210 is rotated in the firstdirection. Correspondingly, referring to FIG. 800 , the clip feedingdrive 124240 is retracted proximally and the clip crimping drive 124250is advanced distally to perform the clip crimping stroke when the driveshaft 124210 is rotated in a second, or opposite, direction. As aresult, the clip feeding stroke and the crimping stroke are notperformed at the same time; rather, they are performed in an alternatingmanner. Further to the above, the drive shaft 124210 comprises flanges124211 and 124213 extending therefrom configured to keep the clipfeeding drive 124240 and the clip crimping drive 124250 from becomingdecoupled from their respective threaded portions of the drive shaft124210.

As discussed above, the first threaded section 124212 and the secondthreaded section 124214 have opposite threads, i.e., one has left-handthreads and the other has right-hand threads, which means that the clipfeeding drive and the clip crimping drive move in opposite directions.In various instances, the threads of the first threaded section 124212,or first threads, have a first pitch and the threads of the secondthreaded section 124214, or second threads, have a second pitch which isthe same as the first pitch. Such an arrangement would cause the clipfeeding drive and the clip crimping drive to move at the same speed andwould be useful when the stroke of the clip feeding drive and the strokeof the clip crimping drive have the same length. Alternatively, thefirst pitch and the second pitch are different. Such an arrangementwould cause the clip feeding drive and the clip crimping drive to moveat different speeds and would be useful when the stroke of the clipfeeding drive and the stroke of the clip crimping drive have differentlengths. Embodiments in which the clip feeding system and the clipcrimping system are operated by different drive shafts could be operatedat different speeds, operated at different or overlapping times, and/oroperated to provide different stroke lengths.

As discussed above, the first threaded section 124212 and the secondthreaded section 124214 drive different functions of the surgical system124200. In at least one instance, the first threaded section 124212 canbe adapted to perform a first function of a surgical system and thesecond threaded section 124214 can be adapted to lock out the firstfunction in certain instances.

Ad discussed above, the drive shaft 124210 is rotatable to translate twodifferent drive members. That said, the drive shaft 124210, itself, isnot translatable; however, alternative embodiments are envisioned inwhich the drive shaft 124210 is both rotatable and translatable. In atleast one instance, one of the drives driven by the drive shaft 124210can be fixed to a frame of the shaft assembly such that the rotation ofthe drive shaft 124210 displaces the drive shaft 124210 longitudinally.The rotation of the drive shaft 124210 would also drive the second drivesystem longitudinally at the same time. Such an arrangement can amplify,or double, the drive motion created by the rotation of the drive shaft124210.

A surgical system 125000 is illustrated in FIGS. 801-803 . The surgicalsystem 125000 comprises a handle, a shaft assembly 125020 extending fromthe handle, and an end effector extending from the shaft assembly125020. The shaft assembly 125020 comprises a rotatable drive shaft125010 and a drive nut 125030 mounted thereto which is configured totranslate longitudinally between a first, or proximal, position and asecond, or distal, position to shift the shaft assembly 125020 between afirst operating configuration and a second operating configuration. Thedrive nut 125030 comprises a first set of drive projections 125034 and asecond set of drive projections 125035 extending therefrom. When thedrive nut 125030 is in its first, or proximal, position, as illustratedin FIG. 802 , the first drive projections 125034 are operably engagedwith a first drive gear 125044 mounted to a frame 125040 of the endeffector such that the rotation of the drive shaft 125010 is transferredto the frame 125040 and the end effector rotates about a longitudinalaxis. When the drive nut 125030 is in its second, or distal, position,as illustrated in FIG. 803 , the second drive projections 125035 areoperably engaged with a second drive gear 125055 of a jaw drive system125050 of the end effector such that the rotation of the drive shaft125010 opens and closes the jaws of the end effector, depending on thedirection in which the drive shaft 125010 is turned. Notably, the firstdrive gear 125044 and the second drive gear 125055 are spaced apartsufficiently such that the drive nut 125030 is not operably engaged withthe end effector rotation drive and the jaw drive at the same time.Moreover, the shaft assembly 125020 further comprises a biasing member,such as a spring, for example, configured to bias the drive nut 125044into one of the first and second positions such that the drive nut125044 does not get stuck in an intermediate position. In at least oneinstance, the shaft assembly 125020 comprises a bi-stable compliantmechanism configured to bias the drive nut 125044 toward the closestposition of the first and second positions.

A surgical system 125100 is illustrated in FIG. 804 . The surgicalsystem 125100 comprises a handle, a shaft assembly 125120 extending fromthe handle, and an end effector releasably attachable to the shaftassembly 125120. The shaft assembly 125120 comprises an elongate portion125121 and a distal portion 125122 rotatably connected to the elongateportion 125121 about an articulation joint 125180. The distal portion125122 of the shaft assembly 125120 comprises a rotation joint 125190configured to permit the end effector to rotate relative to the shaftassembly 125120 about a longitudinal axis. The shaft assembly 125120further comprises a drive shaft 125110 configured to be rotated torotate the end effector about its longitudinal axis and, also,translated proximally and distally to open and close the jaws of the endeffector. The shaft assembly 125120 also comprises push-pullarticulation actuators 125412 and 125414 which are moved proximally anddistally at the same time, but in different directions, to articulatethe distal shaft end 125122 and the end effector about the articulationjoint 125180. The articulation actuators 125412 and 125414 are drivenlongitudinally by a rotatable input drive 125140 threadably engaged withthe proximal ends of the articulation actuators 125412 and 125414.

Notably, further to the above, the drive shaft 125110, which extendsthrough the articulation joint 125180, is sufficiently flexible toaccommodate the articulation of the end effector. Moreover, the driveshaft 125110 comprises an expansion joint which accommodates theexpansion and contraction of the drive shaft 125110 that may occur whenthe drive shaft 125110 flexes to accommodate the articulation of the endeffector. The drive shafts depicted in FIG. 781 , for example, canprovide such expansion and contraction.

A surgical system 126000 is illustrated in FIGS. 805 and 806 . Thesurgical system 126000 comprises a handle, a shaft assembly 126020extending from the handle, and an end effector 126030 releasablyattachable to the shaft assembly 126020. The shaft assembly 126020comprises a frame 126021 and a distal end, wherein the distal end isrotatably connected to the frame 126021 about an articulation joint126080. The shaft assembly 126020 further comprises a rotatable driveshaft 126040 configured to articulate the distal shaft end—and the endeffector 126030 attached thereto—about the articulation joint 126080.When the drive shaft 126040 is rotated in a first direction, the endeffector 126030 is articulated in a first direction and, when the driveshaft 126040 is rotated in a second direction, the end effector 126030is articulated in a second, or opposite, direction. The end effector126030 comprises a frame 126031 rotatably connected to the distal end ofthe shaft assembly 126020 about a rotation joint 126090 such that theend effector 126030 can rotate relative to the shaft assembly 126020about a longitudinal axis. The end effector 126030 further comprisesjaws 126032 which are drivable into an open position to dissect thetissue of a patient and/or a closed position to grasp the tissue of apatient, for example. The shaft assembly 126020 comprises a rotatabledrive shaft 126010 which, as described in greater detail below, isshiftable between first and second positions to selectively rotate theend effector 126030 about the rotation joint 126090 and to drive thejaws 126032 between their open and closed positions.

Further to the above, the drive shaft 126010 of the shaft assembly126020 comprises a distal end which is engaged with a drive element126050 positioned in the end effector 126030 when the end effector126030 is assembled to the shaft assembly 126020. The drive element126050 comprises a socket configured to releasably engage the distal endof the drive shaft 126010 such that the drive element 126050 rotates andtranslates with the drive shaft 126010. The drive shaft 126010 and thedrive element 126050 are positionable in a first, or proximal, positionin which the drive element 126050 is engaged with a geared face of theend effector frame 126031. In such instances, the end effector 126030rotates with the drive shaft 126010. More specifically, the end effector126030 rotates in a first direction when the drive shaft 126010 isrotated in a first direction and in a second, or opposite, directionwhen the drive shaft 126010 is rotated in a second, or opposite,direction. The drive shaft 126010 and the drive element 126050 are alsopositionable in a second, or distal, position in which the drive element126050 is engaged with the jaw drive such that jaws 126032 are movedinto their closed position when the drive shaft 126010 is rotated in afirst direction and into their open position when the drive shaft 126010is rotated in a second, or opposite, direction.

Referring to FIG. 805 , the end effector 126030 is releasably attachableto the shaft assembly 126020. To assemble the end effector 126030 to theshaft assembly 126020, referring to FIG. 806 , the end effector 126030and the shaft assembly 126020 are moved toward one another along alongitudinal axis until the frame 126031 of the end effector 126030couples to the rotation joint 126090. The rotation joint 126090comprises flexible locks 126091 which deflect inwardly as the endeffector 126030 is being attached to the shaft assembly 126020 and thenresiliently deflect outwardly to lock behind lock shoulders defined inthe end effector frame 126031. At the same time that the end effectorframe 126031 is being coupled to the rotation joint 126090, the driveshaft 126010 is being coupled to the end effector drive element 126050as described above. The shaft assembly 126020 further comprises locksupports 126092 configured to hold the flexible locks 126091 in theirlocked configuration to prevent the end effector 126030 from becomingunintentionally decoupled from the shaft assembly 126020. The locksupports 126092 are retractable by the clinician to permit the flexiblelocks 126091 to deflect and allow the end effector 126030 to be detachedfrom the shaft assembly 126020.

As discussed above, the distal end of the drive shaft 126010 isconfigured to be releasably engaged with a socket defined in the driveelement 126050 such that the drive element 126050 is retained to thedrive shaft 126010. This can be accomplished by the interconnectiondepicted in FIG. 807 , for example, discussed below.

A surgical system 126100 is illustrated in FIG. 807 . The surgicalsystem 126100 comprises a handle, a shaft assembly extending from thehandle, and an end effector releasably attachable to the shaft assembly.The shaft assembly comprises a rotatable drive shaft 126120 which isengaged with a rotatable drive shaft 126130 of the end effector when theend effector is assembled to the shaft assembly. The distal end of thedrive shaft 126020 comprises a hex head configuration, for example,comprising a plurality of flexible lock arms 126122 separated by one ormore clearance slots 126124 defined in the drive shaft 126020. Theclearance slots 126124 permit the lock arms 126122 to deflect inwardlywhen the distal end of the drive shaft 126020 is inserted into ahexagonal drive socket, for example, defined in the proximal end of theend effector drive shaft 126130. The drive socket comprises a lead-in,or ramp, 126132 configured to receive the distal end of the drive shaft126120. In such instances, the lock arms 126122 of the drive shaft126120 engage the ramp 126132 and deflect inwardly. As the drive shaft126010 is pushed deeper into the drive socket, the lock arms 126122clear the apex of the ramp 126132 and resiliently deflect outwardlybehind a back ramp 126134. At such point, the lock arms 126122 aresubstantially constrained by the sidewalls 126138 of the drive socketand the rotation of the drive shaft 16120 is transferrable to the endeffector drive shaft 126130. The back ramp 126134 inhibits the driveshaft 126120 from becoming decoupled from the end effector shaft 126130;however, the drive shaft 126120 can be detached from the end effector126130 if a sufficient relative pulling force is applied thereto. Insuch instances, the lock arms 126122 would deflect inwardly once againto cross over the apex between the ramp 126132 and the back ramp 126134.The drive socket further comprises a slot or groove 126136 configured toprovide clearance for the lock arms 126122 to deflect.

A surgical system 127000 is illustrated in FIGS. 808-810 . The surgicalsystem 127000 comprises a handle, a shaft assembly 127020 extending fromthe handle, and an end effector attachable to the shaft assembly 127020.The shaft assembly 127020 comprises an elongate portion 127021 and adistal end portion 127022 rotatably connected to the elongate portion127021 about an articulation joint 127080. The shaft assembly 127020further comprises an articulation drive system 127010 configured toarticulate the distal end portion 127022 of the shaft assembly 127020about the articulation joint 127080. The articulation drive system127010 comprises an electric drive motor 127011 and a rotatable driveshaft 127012 including a threaded end which is rotated by the drivemotor 127011. The threaded end of the drive shaft 127012 is threadablyengaged with a shifter 127040 configured to be selectively engaged witha first, or left, articulation bar 127050 and a second, or right,articulation bar 127060 of the articulation drive system 127010. Whenthe shifter 127040 is engaged with the left articulation bar 127050, asillustrated in FIG. 808 , the drive shaft 127012 can be rotated to pullthe left articulation bar 127050 proximally and articulate the distalend portion 127022, and the end effector attached thereto, to the left.The drive shaft 127012 can be rotated in the opposite direction toreturn the distal end portion 127022 back to its unarticulated positionusing the left articulation bar 127050. Notably, the shifter 127040 isnot operably engaged with the right articulation bar 127060 when theshifter 127040 is operably engaged with the left articulation bar127050.

Further to the above, the left articulation bar 127050 comprises aninwardly-extending arm 127054 which is grabbed by the shifter 127040 topush and pull the left articulation bar 127050. The left articulationbar 127050 also comprises a distal end coupled to the distal end portion127022 at a pin joint 127052 configured to transfer the translationalmotion of the left articulation bar 127050 to the distal end portion127022 and articulate the end effector. When the shifter 127040 isengaged with the right articulation bar 127060, as illustrated in FIG.809 , the drive shaft 127012 can be rotated to pull the rightarticulation bar 127060 proximally and articulate the distal end portion127022 and the end effector to the right. The drive shaft 127012 can berotated in the opposite direction to return the distal end portion127022 back to its unarticulated position using the right articulationbar 127060. The right articulation bar 127060 comprises aninwardly-extending arm 127064 which is grabbed by the shifter 127040 topush and pull the right articulation bar 127050. The right articulationbar 127060 also comprises a distal end coupled to the distal end portion127022 at a pin joint 127052 configured to transfer the translationalmotion of the right articulation bar 127060 to the distal end portion127022 to articulate the end effector. Notably, the shifter 127040 isnot operably engaged with the left articulation bar 127050 when theshifter 127040 is operably engaged with the left articulation bar127060.

Referring primarily to FIG. 810 , the shaft assembly 127020 comprises ashift block 127030 fixedly mounted to the elongate portion 127021 of theshaft assembly 127020. The shift block 127030 is configured to confinethe motion of the shifter 127040 such that the shifter 127040 moveslongitudinally to push and pull the left articulation bar 127050 whenthe shifter 127040 is rotated to the left and push and pull the rightarticulation bar 127050 when the shifter 127050 is rotated to the right,as described above. The shift block 127030 comprises a guide track127032 defined therein which defines the motion path for the shifter127040. The shifter 127040 comprises a projection 127042 extendingtherefrom which is positioned in the guide track 127032 and isconfigured to follow the path defined by the guide track 127032. Theguide track 127032 comprises a left longitudinal slot 127034, a rightlongitudinal slot 127036, and a central slot 127035 extending betweenand connecting the left longitudinal slot 127034 and the rightlongitudinal slot 127036. When the shifter 127040 is rotated to theleft, the projection 127042 is positioned in the left longitudinal slot127034 which constrains the shifter 127040 from rotating and limits themotion of the shifter 127040 to longitudinal motion within the leftlongitudinal slot 127034. When the drive shaft 127012 is rotated in afirst direction in such instances, the shifter 127040 moves proximallywithin the left longitudinal slot 127034 and, when the drive shaft127012 is rotated in a second, or opposite, direction, the shifter127040 moves distally within the left longitudinal slot 127034. When theshifter 127040 is rotated to the right, the projection 127042 ispositioned in the right longitudinal slot 127036 which constrains theshifter 127040 from rotating and limits the motion of the shifter 127040to longitudinal motion within the right longitudinal slot 127036. Whenthe drive shaft 127012 is rotated in a first direction in suchinstances, the shifter 127040 moves proximally within the rightlongitudinal slot 127036 and, when the drive shaft 127012 is rotated ina second, or opposite, direction, the shifter 127040 moves distallywithin the right longitudinal slot 127036. The central slot 127035permits the shifter 127040 to be rotated by the drive shaft 127012between the left and right longitudinal slots 127034 and 127036 asmentioned above.

A shaft assembly 127020′ of a surgical system 127000′ is illustrated inFIGS. 811 and 812 and is similar to the shaft assembly 127020 in manyrespects. That said, the shaft assembly 127020′ further comprises a leftarticulation bar 127050′ that comprises two portions connected by apivot. Similarly, the shaft assembly 127020′ comprises a rightarticulation bar 127060′ that also comprises two portions connected by apivot. Such articulation bars can permit larger articulations, such as90 degrees to the left and right, for example, of the distal end portion127022 and the end effector attached thereto. The shaft assembly 127020′further comprises a left biasing member 127055′ configured to apply abiasing force to the left articulation bar 127050′ and a right biasingmember 127065′ configured to apply a biasing force to the rightarticulation bar 127050′ which co-operate to bias the distal end portion127022, and the end effector attached thereto, to an unarticulatedposition, as illustrated in FIG. 811 .

A surgical system 127100 is illustrated in FIG. 813 . The surgicalsystem 127100 comprises a handle, a shaft assembly 127120 extending fromthe handle, and an end effector releasably attachable to the shaftassembly 127120. The shaft assembly 127120 includes a distal end portion127122 rotatable about an articulation joint 127180. The end effector isreleasably attachable to the distal end portion 127122 such that the endeffector articulates with the distal end portion 127122. The shaftassembly 127120 further comprises a first, or left, articulationactuator 127150 configured to pull the distal end portion 127122 to theleft and a second, or right, articulation actuator 127160 configured topull the distal end portion 127122 to the right. The left articulationactuator 127150 and the right articulation actuator 127160 are flexibleto accommodate the articulation of the distal end portion 127122. Invarious instances, such an arrangement can accommodate approximately 60degrees of articulation to the left and approximately 60 degrees ofarticulation to the right.

A surgical system 127200 is illustrated in FIG. 814 . The surgicalsystem 127200 comprises a handle, a shaft assembly 127220 extending fromthe handle, and an end effector releasably attachable to the shaftassembly 127220. The shaft assembly 127220 includes a distal end portion127222 rotatable about an articulation joint. The end effector isreleasably attachable to the distal end portion 127222 such that the endeffector articulates with the distal end portion 127222. The shaftassembly 127220 further comprises a first, or left, articulationactuator 127250 configured to pull the distal end portion 127222 to theleft and a second, or right, articulation actuator 127260 configured topull the distal end portion 127222 to the right. The left articulationactuator 127250 comprises a first link 127251 and a second link 127253rotatably connected at a pin joint 127252. The second link 127253 isflexible, or at least more flexible than the first link 127251. To thisend, the second link 127253 comprises notches 127254 defined therein tomake the second link 127253 flexible. Similarly, the right articulationactuator 127260 comprises a first link 127261 and a second link 127263rotatably connected at a pin joint 127262. The second link 127263 isflexible, or at least more flexible than the first link 127261. To thisend, the second link 127263 comprises notches 127264 defined therein tomake the second link 127263 flexible. In various instances, such anarrangement can accommodate approximately 90 degrees of articulation tothe left and approximately 90 degrees of articulation to the right.

A surgical system 127300 is illustrated in FIG. 815 . The surgicalsystem 127300 comprises a handle, a shaft assembly 127320 extending fromthe handle, and an end effector releasably attachable to the shaftassembly 127320. The shaft assembly 127320 includes a distal end portion127322 rotatable about an articulation joint. The end effector isreleasably attachable to the distal end portion 127322 such that the endeffector articulates with the distal end portion 127322. The shaftassembly 127320 further comprises a first, or left, articulationactuator 127350 configured to pull the distal end portion 127322 to theleft, but it does not comprise a second, or right, articulation actuatorconfigured to pull the distal end portion 127322 to the right. The leftarticulation actuator 127350 is flexible to accommodate the articulationof the distal end portion 127322. In various instances, such anarrangement can provide more articulation in the left direction than theright direction.

A surgical system 128000 is illustrated in FIG. 816 . The surgicalsystem 128000 comprises a handle, a shaft 128020 extending from thehandle, and an end effector 128030 extending from the shaft 128020. Inalternative embodiments, the surgical system 128000 comprises a housingconfigured to be mounted to a robotic surgical system. In at least onesuch embodiment, the shaft 128020 extends from the robotic housing mountinstead of the handle. In either event, the end effector 128030comprises jaws 128040 and 128050 which are closeable to grasp a target,such as the tissue T of a patient and/or a suture needle, for example,as discussed in greater detail below. The jaws 128040 and 128050 arealso openable to dissect the tissue of a patient, for example. In atleast one instance, the jaws 128040 and 128050 are insertable into thepatient tissue to create an otomy therein and then spread to open theotomy, as discussed in greater detail below.

Referring again to FIG. 816 , the jaws 128040 and 128050 are pivotablycoupled to the shaft 128020 about a pivot joint 128060. The pivot joint128060 defines a fixed axis of rotation, although any suitablearrangement could be used. The jaw 128040 comprises a distal end, ortip, 128041 and an elongate profile which narrows from its proximal endto its distal end 128041. Similarly, the jaw 128050 comprises a distalend, or tip, 128051 and an elongate profile which narrows from itsproximal end to its distal end 128051. The distance between the tips128041 and 128051 define the mouth width, or opening, 128032 of the endeffector 128030. When the tips 128041 and 128051 are close to oneanother, or in contact with one another, the mouth 128032 is small, orclosed, and the mouth angle e is small, or zero. When the tips 128041and 128051 are far apart, the mouth 128032 is large and the mouth anglee is large.

Further to the above, the jaws of the end effector 128030 are driven bya jaw drive system including an electric motor. In use, a voltagepotential is applied to the electric motor to rotate the drive shaft ofthe electric motor and drive the jaw drive system. The surgical system128000 comprises a motor control system configured to apply the voltagepotential to the electric motor. In at least one instance, the motorcontrol system is configured to apply a constant DC voltage potential tothe electric motor. In such instances, the electric motor will run at aconstant speed, or an at least substantially constant speed. In variousinstances, the motor control system comprises a pulse width modulation(PWM) circuit and/or a frequency modulation (FM) circuit which can applyvoltage pulses to the electric motor. The PWM and/or FM circuits cancontrol the speed of the electric motor by controlling the frequency ofthe voltage pulses supplied to the electric motor, the duration of thevoltage pulses supplied to the electric motor, and/or the durationbetween the voltage pulses supplied to the electric motor.

The motor control system is also configured to monitor the current drawnby the electric motor as a means for monitoring the force being appliedby the jaws of the end effector 128030. When the current being drawn bythe electric motor is low, the loading force on the jaws is low.Correspondingly, the loading force on the jaws is high when the currentbeing drawn by the electric motor is high. In various instances, thevoltage being applied to the electric motor is fixed, or held constant,and the motor current is permitted to fluctuate as a function of theforce loading at the jaws. In certain instances, the motor controlsystem is configured to limit the current drawn by the electric motor tolimit the force that can be applied by the jaws. In at least oneembodiment, the motor control system can include a current regulationcircuit that holds constant, or at least substantially constant, thecurrent drawn by the electric motor to maintain a constant loading forceat the jaws.

The force generated between the jaws of the end effector 128030, and/oron the jaws of the end effector 128030, may be different depending onthe task that the jaws are being used to perform. For instance, theforce needed to hold a suture needle may be high as suture needles aretypically small and it is possible that a suture needle may slip duringuse. As such, the jaws of the end effector 128030 are often used togenerate large forces when the jaws are close together. On the otherhand, the jaws of the end effector 128030 are often used to applysmaller forces when the jaws are positioned further apart to performlarger, or gross, tissue manipulation, for example.

Referring to the upper portion 128110 of the graph 128100 illustrated inFIG. 817 , the loading force, f, experienced by the jaws of the endeffector 128030 can be limited by a force profile stored in the motorcontrol system. The force limit profile 128110 o for opening the jaws128040 and 128050 is different than the force limit profile 128110 c forclosing the jaws 128040 and 128050. This is because the proceduresperformed when forcing the jaws 128040 and 128050 open are typicallydifferent than the procedures performed when forcing the jaws 128040 and128050 closed. That said, the opening and closing force limit profilescould be the same. While it is likely that the jaws 128040 and 128050will experience some force loading regardless of whether the jaws 128050are being opened or closed, the force limit profiles typically come intoplay when the jaws 128040 and 128050 are being used to perform aparticular procedure within the patient. For instance, the jaws 128040and 128050 are forced open to create and expand an otomy in the tissueof a patient, as represented by graph sections 128115 and 128116,respectively, of graph 128100, while the jaws 128040 and 128050 areforced closed to grasp a needle and/or the patient tissue, asrepresented by graph sections 128111 and 128112, respectively, of graph128100.

Referring again to FIG. 817 , the opening and closing jaw force limitprofiles 128110 o and 128110 c, respectively, are depicted on theopposite sides of a zero force line depicted in the graph 128100. As canbe seen in the upper section 128110 of graph 128100, the jaw force limitthreshold is higher—for both force limit profiles 128110 o and 128110c—when the jaws 128040 and 128050 are just being opened from theirfully-closed position. As can also be seen in the upper section 128110of graph 128100, the jaw force limit threshold is lower—for both forcelimit profiles 128110 o and 128110 c—when the jaws 128040 and 128050 arereaching their fully-opened position. Such an arrangement can reduce thepossibility of the jaws 128040 and 128050 damaging adjacent tissue whenthe being fully opened, for example. In any event, the force that thejaws 128040 and 128050 are allowed to apply is a function of the mouthopening size between the jaws and/or the direction in which the jaws arebeing moved. For instance, when the jaws 128040 and 128050 are openedwidely, or at their maximum, to grasp large objects, referring to graphsection 128114 of upper graph section 128110, the jaw force f limit isvery low as compared to when the jaws 128040 and 128050 are more closedto perform gross tissue manipulation, referring to graph section 128113of upper graph section 128110. Moreover, different jaw force limitprofiles can be used for different jaw configurations. For instance,Maryland dissectors, which have narrow and pointy jaws, may have adifferent jaw force limit profile than a grasper having blunt jaws, forexample.

In addition to or in lieu of the above, the speed of the jaws 128040 and128050 can be controlled and/or limited by the motor control system as afunction of the mouth opening size between the jaws 128040 and 128050and/or the direction the jaws are being moved. Referring to the middleportion 128120 and lower portion 128130 of the graph 128100 in FIG. 817, the rate limit profile for moving the jaws 128040 and 128050 permitsthe jaws to be moved slowly when the jaws are near their closed positionand moved quickly when the jaws are near their open position. In suchinstances, the jaws 128040 and 128050 are accelerated as the jaws areopened. Such an arrangement can provide fine control over the jaws128040 and 128050 when they are close together to facilitate the finedissection of tissue, for example. Notably, the rate limit profile foropening and closing the jaws 128040 and 128050 is the same, but theycould be different in other embodiments. In alternative embodiments, therate limit profile for moving the jaws 128040 and 128050 permits thejaws to be moved quickly when the jaws are near their closed positionand slowly when the jaws are near their open position. In suchinstances, the jaws 128040 and 128050 are decelerated as the jaws areopened. Such an arrangement can provide fine control over the jaws128040 and 128050 when the jaws are being used to stretch an otomy, forexample. The above being said, the speed of the jaws 128040 and 128050can be adjusted once the jaws experience loading resistance from thepatient tissue, for example. In at least one such instance, the jawopening rate and/or the jaw closing rate can be reduced once the jaws128040 and 128050 begin to experience force resistance above athreshold, for example.

In various instances, further to the above, the handle of the surgicalsystem 128000 comprises an actuator, the motion of which tracks, or issupposed to track, the motion of the jaws 128040 and 128050 of the endeffector 128030. For instance, the actuator can comprise a scissors-gripconfiguration which is openable and closable to mimic the opening andclosing of the end effector jaws 128040 and 128050. The control systemof the surgical system 128000 can comprise one or more sensor systemsconfigured to monitor the state of the end effector jaws 128040 and128050 and the state of the handle actuator and, if there is adiscrepancy between the two states, the control system can take acorrective action once the discrepancy exceeds a threshold and/orthreshold range. In at least one instance, the control system canprovide feedback, such as audio, tactile, and/or haptic feedback, forexample, to the clinician that the discrepancy exists and/or provide thedegree of discrepancy to the clinician. In such instances, the cliniciancan make mental compensations for this discrepancy. In addition to or inlieu of the above, the control system can adapt its control program ofthe jaws 128040 and 128050 to match the motion of the actuator. In atleast one instance, the control system can monitor the loading forcebeing applied to the jaws and align the closed position of the actuatorwith the position of the jaws when the jaws experience the peak forceloading condition when grasping tissue. Similarly, the control systemcan align the open position of the actuator with the position of thejaws when the jaws experience the minimum force loading condition whengrasping tissue. In various instances, the control system is configuredto provide the clinician with a control to override these adjustmentsand allow the clinician to use their own discretion in using thesurgical system 128000 in an appropriate manner.

A surgical system 128700 is illustrated in FIGS. 818 and 819 . Thesurgical system 128700 comprises a handle, a shaft assembly 128720extending from the handle, and an end effector 128730 extending from theshaft assembly 128720. In alternative embodiments, the surgical system128700 comprises a housing configured to be mounted to a roboticsurgical system. In at least one such embodiment, the shaft 128720extends from the robotic housing mount instead of the handle. In eitherevent, the end effector 128730 comprises shears configured to transectthe tissue of a patient. The shears comprise two jaws 128740 and 128750configured to transect the patient tissue positioned between the jaws128740 and 128750 as the jaws 128740 and 128750 are being closed. Eachof the jaws 128740 and 128750 comprises a sharp edge configured to cutthe tissue and are pivotably mounted to the shaft 128720 about a pivotjoint 128760. Such an arrangement can comprise bypassing scissorsshears. Other embodiments are envisioned in which one of the jaws 128740and 128750 comprises a knife edge and the other comprises a mandrelagainst the tissue is supported and transected. Such an arrangement cancomprise a knife wedge in which the knife wedge is moved toward themandrel. In at least one embodiment, the jaw comprising the knife edgeis movable and the jaw comprising the mandrel is stationary. The abovebeing said, embodiments are envisioned in which the tissue-engagingedges of one or both of the jaws 128740 and 128750 are not necessarilysharp.

As discussed above, the end effector 128730 comprises two scissor jaws128740 and 128750 movable between an open position and a closed positionto cut the tissue of a patient. The jaw 128740 comprises a sharp distalend 128741 and the jaw 128750 comprises a sharp distal end 128751 whichare configured to snip the tissue of the patient at the mouth 128731 ofthe end effector 128730, for example. That said, other embodiments areenvisioned in which the distal ends 128741 and 128751 are blunt and canbe used to dissect tissue, for example. In any event, the jaws aredriven by a jaw drive system including an electric drive motor, thespeed of which is adjustable to adjust the closure rate and/or openingrate of the jaws. Referring to the graph 128400 of FIG. 820 , thecontrol system of the surgical system is configured to monitor theloading, or shear, force on the jaws 128740 and 128750 as the jaws128740 and 128750 are being closed and adaptively slow down the drivemotor when large forces, or forces above a threshold Fc, are experiencedby the jaws 128740 and 128750. Such large forces often occur when thetissue T being cut by the jaws 128740 and 128750 is thick, for example.Similar to the above, the control system can monitor the current drawnby the drive motor as a proxy for the loading force being experienced bythe jaws 128740 and 128750. In addition to or in lieu of this approach,the control system can be configured to measure the jaw loading forcedirectly by one or more load cells and/or strain gauges, for example.Once the loading force experienced by the jaws 128740 and 128750 dropsbelow the force threshold Fc, the control system can adaptively speed upthe jaw closure rate. Alternatively, the control system can maintain thelower closure rate of the jaws 128740 and 128750 even though the forcethreshold is no longer being exceeded.

The above-provided discussion with respect to the surgical system 128700can provide mechanical energy or a mechanical cutting force to thetissue of a patient. That said, the surgical system 128700 is alsoconfigured to provide electrosurgical energy or an electrosurgicalcutting force to the tissue of a patient. In various instances, theelectrosurgical energy comprises RF energy, for example; however,electrosurgical energy could be supplied to the patient tissue at anysuitable frequency. In addition to or in lieu of AC power, the surgicalsystem 128700 can be configured to supply DC power to the patienttissue. The surgical system 128700 comprises a generator in electricalcommunication with one or more electrical pathways defined in theinstrument shaft 128720 which can supply electrical power to the jaws128740 and 128750 and also provide a return path for the current. In atleast one instance, the jaw 128740 comprises an electrode 128742 inelectrical communication with a first electrical pathway in the shaft128720 and the jaw 128750 comprises an electrode 128752 in electricalcommunication with a second electrical pathway in the shaft 128720. Thefirst and second electrical pathways are electrically insulated, or atleast substantially insulated, from one another and the surroundingshaft structure such that the first and second electrical pathways, theelectrodes 128742 and 128752, and the tissue positioned between theelectrodes 128742 and 128752 forms a circuit. Such an arrangementprovides a bipolar arrangement between the electrodes 128742 and 128752.That said, embodiments are envisioned in which a monopolar arrangementcould be used. In such an arrangement, the return path for the currentgoes through the patient and into a return electrode positioned on orunder the patient, for example.

As discussed above, the tissue of a patient can be cut by using amechanical force and/or an electrical force. Such mechanical andelectrical forces can be applied simultaneously and/or sequentially. Forinstance, both forces can be applied at the beginning of a tissuecutting actuation and then the mechanical force can be discontinued infavor of the electrosurgical force finishing the tissue cuttingactuation. Such an approach can apply an energy-created hemostatic sealto the tissue after the mechanical cutting has been completed. In sucharrangements, the electrosurgical force is applied throughout theduration of the tissue cutting actuation. In other instances, themechanical cutting force, without the electrosurgical cutting force, canbe used to start a tissue cutting actuation which is then followed bythe electrosurgical cutting force after the mechanical cutting force hasbeen stopped. In such arrangements, the mechanical and electrosurgicalforces are not overlapping or co-extensive. In various instances, boththe mechanical and electrosurgical forces are overlapping andco-extensive throughout the entire tissue cutting actuation. In at leastone instance, both forces are overlapping and co-extensive throughoutthe entire tissue cutting actuation but in magnitudes or intensitiesthat change during the tissue cutting actuation. The above being said,any suitable combination, pattern, and/or sequence of mechanical andelectrosurgical cutting forces and energies could be used.

Further to the above, the surgical system 128700 comprises a controlsystem configured to co-ordinate the application of the mechanical forceand electrosurgical energy to the patient tissue. In various instances,the control system is in communication with the motor controller whichdrives the jaws 128740 and 128750 and, also, the electrical generatorand comprises one or more sensing systems for monitoring the mechanicalforce and electrosurgical energy being applied to the tissue. Systemsfor monitoring the forces within a mechanical drive system are disclosedelsewhere herein. Systems for monitoring the electrosurgical energybeing applied to the patient tissue include monitoring the impedance, orchanges in the impedance, of the patient tissue via the electricalpathways of the electrosurgical circuit. In at least one instance,referring to the graph 128800 in FIG. 821 , the RF current/voltage ratioof the electrosurgical power being applied to the patient tissue by thegenerator is evaluated by monitoring the current and voltage of thepower being supplied by the generator. The impedance of the tissue andthe RF current/voltage ratio of the electrosurgical power are a functionof many variables such as the temperature of the tissue, the density ofthe tissue, the thickness of the tissue, the type of tissue between thejaws 128740 and 128750, the duration in which the power is applied tothe tissue, among others, which change throughout the application of theelectrosurgical energy.

Further to the above, the control system and/or generator of thesurgical system 128700 comprises one or more ammeter circuits and/orvoltmeter circuits configured to monitor the electrosurgical currentand/or voltage, respectively, being applied to the patient tissue.Referring again to FIG. 821 , a minimum amplitude limit and/or a maximumamplitude limit on the current being applied to the patient tissue canbe preset in the control system and/or can be controllable by the userof the surgical instrument system through one or more input controls.The minimum and maximum amplitude limits can define a current envelopewithin which the electrosurgical portion of the surgical system 128700is operated.

In various instances, the control system of the surgical system 128700is configured to adaptively increase the electrosurgical energy appliedto the patient tissue when the drive motor slows. The motor slowing canbe a reaction to an increase in the tissue cutting load and/or anadaptation of the control system. Similarly, the control system of thesurgical system 128700 is configured to adaptively increase theelectrosurgical energy applied to the patient tissue when the drivemotor stops. Again, the motor stopping can be a reaction to an increasein the tissue cutting load and/or an adaptation of the control system.Increasing the electrosurgical energy when the electric motor slowsand/or stops can compensate for a reduction in mechanical cuttingenergy. In alternative embodiments, the electrosurgical energy can bereduced and/or stopped when the electric motor slows and/or stops. Suchembodiments can afford the clinician to evaluate the situation in alow-energy environment.

In various instances, the control system of the surgical system 128700is configured to adaptively decrease the electrosurgical energy appliedto the patient tissue when the drive motor speeds up. The motor speedingup can be a reaction to a decrease in the cutting load and/or anadaptation of the control system. Decreasing the electrosurgical energywhen the electric motor slows and/or stops can compensate for, orbalance out, an increase in mechanical cutting energy. In alternativeembodiments, the electrosurgical energy can be increased when theelectric motor speeds up. Such embodiments can accelerate the closure ofthe jaws and provide a clean, quick cutting motion.

In various instances, the control system of the surgical system 128700is configured to adaptively increase the speed of the drive motor whenthe electrosurgical energy applied to the patient tissue decreases. Theelectrosurgical energy decreasing can be a reaction to a change intissue properties and/or an adaptation of the control system. Similarly,the control system of the surgical system 128700 is configured toadaptively increase the speed of the drive motor when electrosurgicalenergy applied to the patient tissue stops in response to an adaptationof the control system. Increasing the speed of the drive motor when theelectrosurgical energy decreases or is stopped can compensate for areduction in electrosurgical cutting energy. In alternative embodiments,the speed of the drive motor can be reduced and/or stopped when theelectrosurgical energy decreases and/or is stopped. Such embodiments canafford the clinician to evaluate the situation in a low-energy and/orstatic environment.

In various instances, the control system of the surgical system 128700is configured to adaptively decrease the speed of the electric motorwhen the electrosurgical energy applied to the patient tissue increases.The electrosurgical energy increasing can be a reaction to a change intissue properties and/or an adaptation of the control system. Decreasingthe drive motor speed when the electrosurgical energy increases cancompensate for, or balance out, an increase in electrosurgical cuttingenergy. In alternative embodiments, the drive motor speed can beincreased when the electrosurgical energy increases. Such embodimentscan accelerate the closure of the jaws and provide a clean, quickcutting motion.

In various instances, the surgical system 128700 comprises controls,such as on the handle of the surgical system 128700, for example, that aclinician can use to control when the mechanical and/or electrosurgicalforces are applied. In addition to or in lieu of manual controls, thecontrol system of the surgical system 128700 is configured to monitorthe mechanical force and electrical energy being applied to the tissueand adjust one or the other, if needed, to cut the tissue in a desirablemanner according to one or more predetermined force-energy curves and/ormatrices. In at least one instance, the control system can increase theelectrical energy being delivered to the tissue once the mechanicalforce being applied reaches a threshold limit. Moreover, the controlsystem is configured to consider other parameters, such as the impedanceof the tissue being cut, when making adjustments to the mechanical forceand/or electrical energy being applied to the tissue.

As surgical techniques continue to advance and develop, there is a needfor specialized surgical instruments. With the advent of 3-D printingand additive manufacturing, new methods and techniques have beendeveloped to produce specialized surgical instruments. Customizedsurgical instruments can allow a technician or surgeon to produce anduse surgical instruments that are customized to a patient'sphysiological conditions or for a specific surgical procedure.

Out of an abundance of caution, many surgical instruments have becomeone-use devices to prevent the spread of contamination or diseasesbetween patients. As surgical devices are becoming single patient andsingle-use devices, customizing the devices for the specific patient canallow for better results and faster recovery time for patients. Asrecovery time for patients is a substantial cost to the healthcaresystem, having customized surgical devices that allow surgeons tospecifically target and resolve a patient's ailment can greatly reducethe overall healthcare spend.

Surgical instruments, such as surgical dissectors have been inwidespread use in various surgical procedures. These instruments allow asurgeon to manipulate, separate, and remove specific areas of tissue ofa patient. Having the ability to develop custom dissectors for specificsurgical procedures and for a patient's physiological conditions can beof great value.

As different surgical procedures and patient conditions requiredifferent surgical instruments, the present disclosure relates tocustomized surgical devices, methods of producing customized devices,and means for producing customized surgical devices using varioustechniques, such as additive manufacturing and/or 3-D printing, forexample.

In developing customized surgical devices, a surgeon can determine thespecifics of the required device based upon the specific procedure, thegeneral size of the patient, i.e., a child vs. an adult, or throughscans and/or x-rays of the patient to determine the specific profilerequired for the surgical instrument.

When a surgeon is customizing a surgical instrument for a specificprocedure, they may consult a directory of predefined surgicalinstrument shapes and configurations to determine which device may bestsuit the procedure at hand. Such procedures for the production ofultrasonic blades are discussed in U.S. Patent Application PublicationNo. 2018/0014844, entitled ULTRASONIC SURGICAL INSTRUMENT WITH AS HOCFORMED BLADE, the disclosure of which is incorporated by reference inits entirety.

Once the surgeon determines the desired device characteristics, thesurgeon may take a base device, such as a end effector connector havinga core or stub and use an additive manufacturing process to produce theselected end effector configuration. In addition, or in the alternative,a surgeon may use the size of a patient to determine the required sizeof the surgical instrument. The surgeon may use various physiologicalstandards, such as the size of the patients hand, tibia, abdomen, orother physiological marker that can provide an adequate representationof the desired size of the surgical instrument. In addition, or in thealternative, the surgeon may conduct scans or x-rays of the patient todetermine the specific size, shape, and characteristic of the surgicaldevice needed to perform a desired procedure.

FIG. 822 illustrates a surgical end effector 100000 having a standardconnection portion 100050 and a customizable end effector portion100060. The standard connection portion 100050 includes a first jawportion 100006 and a second jaw portion 100008. The first jaw portion100006 and the second jaw portion 100008 are rotatable about a joint100004. The standard connection portion 100050 of the surgical endeffector 100000 can be connected to a shaft of a surgical instrument.The shaft of the surgical instrument can have a diameter D. Thecustomizable end effector portion 100060 can be customized within thecustomization region 100002, such that the diameter of the customizationregion 100002 is equal to or less than the diameter D of the shaft ofthe surgical instrument. With the customizable end effector portion100060 being confined to the bounds of the customization region 100002,the surgical end effector 100000 can be inserted through a trocar into apatient's body cavity through minimally invasive surgical procedures.

The first jaw portion 100006 of the end effector portion 100060 includesa core/stub portion 100010 that is adaptable through additivemanufacturing techniques. The core/stub portion 100010 provides a basefor building and customizing the geometry and characteristics of acustomizable jaw 100012. Depending on various needs for the surgicalprocedure, the customizable jaw 100012 can be modified and adapted tomeet the needs of the surgeon.

In certain embodiments, the surgical end effector 100000 can comprise asolid customizable region 100002. The solid customizable region 100002can be made of various materials such as various metals and/or plastics,for example. When the surgeon determines the configuration required forthe surgical procedure, the surgeon can use a manufacturing technique toremove the excess material to leave the desired shape of thecustomizable jaw 100012. In the alternative, the surgeon may start witha surgical end effector 100000 that does not have a core/stub portion100100 and, instead, only has a standard connector portion 100050. Withjust the standard connector portion 100050, the surgeon can use amanufacturing process to create the desired shape and features of thecustomized jaw 100012 within the bounds of the customization region100002.

In another embodiment, a surgical instrument may have a surgical endeffector 100100, as illustrated in FIG. 823 . The surgical end effector100100 has a standard connection portion 100150 and a customizable endeffector portion 100160. The standard connection portion 100150 includesa first jaw portion 100106 and a second jaw portion 100108. The firstjaw portion 100106 and the second jaw portion 100108 are rotatable abouta joint 100104. The standard connection portion 100150 of the surgicalend effector 100100 can be connected to a shaft of a surgicalinstrument. The shaft of the surgical instrument can have a diameter D.The customizable end effector portion 100160 can be customized withinthe customization region 100102 such that the diameter of thecustomization region 100102 is equal to or less than the diameter D ofthe shaft of the surgical instrument. With the customizable end effectorportion 100160 being confined to the bounds of the customization region100102, the surgical end effector 100100 can be inserted through atrocar into a patient's body cavity through minimally invasive surgicalprocedures.

The first jaw portion 100106 of the end effector portion 100160 includesa core/stub portion 100110 that is adaptable through additivemanufacturing techniques. The core/stub portion 100110 provides a basefor building and customizing the geometry and characteristics of a firstcustomizable jaw 100112 and a second customizable jaw 100114. Dependingon various needs for the surgical procedure, the first customizable jaw100112 and the second customizable jaw 100114 can be modified andadapted to meet the needs of the surgeon. The first customizable jaw100112 and the second customizable jaw 100114 have a plurality ofproximal features 100118 and a plurality of distal features 100116. Asillustrated in FIG. 823 , the plurality of proximal features 100118comprises a plurality of proximal teeth. The plurality of distalfeatures 100116 comprises a plurality of distal teeth. The proximalteeth are smaller and have a smaller height than the distal teeth. Theprogression of larger distal teeth to smaller proximal teeth can allowfor a more aggressive hold and manipulation of tissue when using thedistal portion of the first and second customizable jaws 100112, 100114.In various embodiments, however, the plurality of proximal and distalteeth may take various configurations based upon the needs of thesurgical procedure, such as for example, a plurality of symmetricalteeth, a plurality of asymmetrical teeth, and/or a progression fromlarge to small or small to large teeth.

In certain embodiments, the surgical end effector 100100 comprises asolid customized region 100102. The solid customizable region 100002 canbe made of various materials such as various metals and/or plastics, forexample. When the surgeon determines the configuration of the endeffector 100100 required for the surgical procedure, the surgeon can usea manufacturing technique, such as grinding, wire EDMing, and/orpolishing, for example, to remove the excess material to leave thedesired shape of the customizable jaw 101012. In the alternative, thesurgeon may start with a surgical end effector 100100 that only has astandard connector portion 100150. With just the standard connectorportion 100150, the surgeon can use a manufacturing process to createthe desired shape and features of the customized jaw 100112 within thebounds of the customization region 100102.

FIG. 824 illustrates a surgical end effector 100200 that is configuredto be modified and adjusted using various manufacturing techniques atthe discretion of a surgeon. The surgical end effector 100200 includes astandard connection portion 100250 and a customizable end effectorportion 100260. The standard connection portion 100250 includes a firstjaw portion 100206 and a second jaw portion 100208.

The customizable end effector portion 100260 can be customized withinthe customization region 100202, such that the diameter of thecustomization region 100202 is equal to or less than the diameter D ofthe shaft of the surgical instrument. With the customizable end effectorportion 100260 being confined to the bounds of the customization region100202, the surgical end effector 100200 can be inserted through atrocar into a patient's body cavity during minimally invasive surgicalprocedures.

The surgical end effector 100200 is illustrated as having variousdifferent customized jaw configurations 100212 a-e. The variouscustomized jaw configurations 100212 a-e can be selected by a surgeon orclinician depending upon the type of procedure and a patient'sphysiological condition. The various customized jaw configurations100212 a-e can include different shape profiles, different diameters,different geometries, and can be comprised of various materials. In oneembodiment, the various customized jaw configurations 100212 a-e can becomprised of various plastics having different durometers anddeformation characteristics. In another embodiment, the variouscustomized jaw configurations 100212 a-e can comprise metallic materialsand materials having a greater rigidity. In addition, or in thealternative, the various customized jaw configurations 100212 a-e canalso comprise a combination of metallic and plastic materials to providea desired characteristic to the surgical end effector 100200.

In certain embodiments, the various customized jaw configurations 100212a-e can have a metallic core with plastic and/or metal overlaid upon thecore. The various materials used in the various customized jawconfigurations 100212 a-e can create end effectors meeting the needs ofthe surgeon, procedure, and/or patient.

FIG. 825 illustrates a surgical end effector 100300 that is configuredto be modified and adjusted using various manufacturing techniques atthe discretion of a surgeon. The surgical end effector 100300 includes astandard connection portion 100350 and a customizable end effectorportion 100360. The standard connection portion 100350 includes a firstjaw portion 100306 and a second jaw portion 100308. The first jawportion 100306 and the second jaw portion 100308 are rotatable about ajoint 100304.

The customizable end effector portion 100360 can be customized withinthe customization region 100302, such that, the diameter of thecustomization region 100302 is equal to or less than the diameter D ofthe shaft of the surgical instrument. With the customizable end effectorportion 100360 being confined to the bounds of the customization region100302, the surgical end effector 100300 can be inserted through atrocar into a patient's body cavity through minimally invasive surgicalprocedures.

The first jaw portion 100306 of the end effector portion 100360 includesa core/stub portion 100310 that is adaptable through additivemanufacturing techniques. The core/stub portion 100310 provides a basefor building and customizing the geometry and characteristics of a firstcustomizable jaw 100312 and a second customizable jaw 100314. Dependingon various needs for the surgical procedure, the first customizable jaw100312 and the second customizable jaw 100314 can be modified andadapted to meet the needs of the surgeon. The first customizable jaw100312 and the second customizable jaw 100314 have a plurality ofproximal features 100318 and a plurality of distal features 100316. Asillustrated in FIG. 825 , the plurality of proximal features 100318comprises a plurality of proximal teeth. The plurality of distalfeatures 100316 comprises a plurality of distal teeth. The plurality ofproximal teeth is approximately the same height as the plurality ofdistal teeth. However, in various embodiments the plurality of proximaland distal teeth may take various configurations based upon the needs ofthe surgical procedure, for example a plurality of symmetrical teeth, aplurality of asymmetrical teeth, and/or a progression from large tosmall or small to large teeth. In the alternative, the surgical endeffector 100300 can include a plurality of miniature, or fine, teeth100320. The various features 100316, 100318 and miniature teeth 100320can extend along the first customizable jaw 100312 and the secondcustomizable jaw 100314 in various lengths, can have smooth profiles,and/or can have sharper profiles depending on the desired configurationof the surgical end effector 100300.

FIG. 825 illustrates various different customized jaw configurations100322 a-c. In a first embodiment, the customized jaw configuration100322 a can comprise a curved end effector region. In a secondalternative embodiment, the customized jaw configuration 100322 b cancomprise a protruding outer profile that can allow the surgical endeffector 100300 to function as a dissector and divide tissue when thefirst jaw portion 100306 and the second jaw portion 100308 are rotatedabout a joint 100304 between an open configuration and a closedconfiguration. In a third alternative embodiment, the customized jawconfiguration 100322 c can comprise a longitudinal linear body. Otherembodiments and configurations of the surgical end effector 100300 arealso possible. One constraint on the configuration of the customizableend effector portion 100360 is that it should be confined to the boundsof the customization region 100302 so that the surgical end effector100300 can be inserted through a trocar into a patient's body cavitythrough minimally invasive surgical procedures. In embodiments where thesurgical end effector 100300 is being used in open surgical procedures,the customizable end effector portion 100360 can exceed the bounds ofthe customization region 100302. Also, embodiments are envisioned wherea portion of the end effector is collapsible to permit laparoscopic endeffectors to fit through a trocar. In such embodiments, the bounds ofthe customizable region can be larger than the diameter D of the shaft.

FIGS. 826 and 827 illustrate a surgical end effector 100400. Thesurgical end effector 100400 is configured to be modified and adjustedusing various manufacturing techniques at the discretion of a surgeon.The surgical end effector 100400 includes a standard connection portion100450 and a customizable end effector portion 100460. The standardconnection portion 100450 includes a first jaw portion 100406 and asecond jaw portion 100408. The first jaw portion 100406 and the secondjaw portion 100408 are rotatable about a joint 100404.

The customizable end effector portion 100460 can be customized withinthe customization region 100402, such that the diameter of thecustomization region 100402 is equal to or less than the diameter D ofthe shaft of the surgical instrument. With the customizable end effectorportion 100460 being confined to the bounds of the customization region100402, the surgical end effector 100400 can be inserted through atrocar into a patient's body cavity through minimally invasive surgicalprocedures.

The first jaw portion 100406 of the end effector portion 100460 includesa core/stub portion 100410 that is adaptable through additivemanufacturing techniques. The core/stub portion 100410 provides a basefor building and customizing the geometry and characteristics of a firstcustomizable jaw 100412 and a second customizable jaw 100414. Dependingon various needs for the surgical procedure, the first customizable jaw100412 and the second customizable jaw 100414 can be modified andadapted to meet the needs of the surgeon. The first customizable jaw100412 and the second customizable jaw 100414 have a plurality ofproximal features 100418 and a plurality of distal features 100416. Asillustrated in FIG. 827 , the plurality of proximal features 100418comprises a plurality of proximal teeth. The plurality of distalfeatures 100416 comprises a plurality of distal teeth. The plurality ofproximal teeth is approximately the same height as the plurality ofdistal teeth. However, in various embodiments, the plurality of proximaland distal teeth may take various configurations based upon the needs ofthe surgical procedure such as, for example, a plurality of symmetricalteeth, a plurality of asymmetrical teeth, and/or a progression fromlarge to small or small to large teeth.

In addition, the first customizable jaw 100412 and the secondcustomizable jaw 100414 have a plurality of features 100430 and 100432,respectively, that are positioned on the outer portion of the first andsecond customizable jaws 100412, 100414. As illustrated in FIG. 827 ,the features 100430, 100432 can include ridges, or teeth, that allow thesurgical end effector 100400 to engage, grasp, and/or manipulate tissue.

When selecting the configuration and various features for the surgicalend effector 100400, the external features 100430, 100432, the proximalfeatures 100418, the distal features 100416, the overall geometric shapeof the first and second customizable jaws 100412, 100414, and thematerials used in producing the customizable end effector portion 100460are independent variables that are considered during the customizationprocess. For example, when the surgical end effector 100400 is beingcustomized for a minimally invasive surgical procedure, the variousindependent variables must result in an overall profile that fallswithin the customization region 100402 so that the surgical end effector100400 can be inserted through a trocar and into a patient's bodycavity.

FIGS. 828-831 illustrate surgical end effectors having various featuresand profiles. FIG. 828 illustrates a surgical end effector 100500 thatis configured to be modified and adjusted using various manufacturingtechniques at the discretion of a surgeon. The surgical end effector100500 includes a standard connection portion 100550 and a customizableend effector portion 100560. The standard connection portion 100550 caninclude a first jaw portion 100506 and a second jaw portion 100508. Thefirst jaw portion 100506 and the second jaw portion 100508 are rotatableabout a joint 100504.

The customizable end effector portion 100560 can be customized within acustomization region 100502, such that the diameter of the customizationregion 100502 is equal to or less than the diameter D of the shaft ofthe surgical instrument. With the customizable end effector portion100560 being confined to the bounds of the customization region 100502,the surgical end effector 100500 can be inserted through a trocar into apatient's body cavity through minimally invasive surgical procedures.

The customizable end effector portion 100560 can be produced throughvarious additive manufacturing techniques to produce custom geometry andcharacteristics of a first customizable jaw 100512 and a secondcustomizable jaw 100514. Depending on various needs for the surgicalprocedure, the first customizable jaw 100512 and the second customizablejaw 100514 can be modified and adapted to meet the needs of the surgeon.The first customizable jaw 100512 and the second customizable jaw 100514have a plurality of proximal features 100518 and a plurality of distalfeatures 100516. As illustrated in FIG. 828 , the plurality of proximalfeatures 100518 comprises a plurality of small symmetrical proximalteeth. The plurality of distal features 100516 comprises a plurality ofsmall symmetrical distal teeth. The plurality of proximal teeth isapproximately the same height as the plurality of distal teeth and arecontinuous along the inner surfaces of the first customizable jaw 100512and the second customizable jaw 100514. In addition, the firstcustomizable jaw 100512 and the second customizable jaw 100514 compriseexternal surface features 100530, 100532, respectively. As illustratedin FIG. 828 , the external surface features 100530, 100532 comprisesubstantially smooth surfaces. However, in alternative embodiments, theexternal surface features 100530, 100532 may comprise teeth, nubs and/orother protrusions to assist with the tissue interaction of the surgicalend effector 100500.

FIG. 829 illustrates surgical end effector 100600 that is configured tobe modified and adjusted using various manufacturing techniques at thediscretion of a surgeon. The surgical end effector 100600 includes astandard connection portion 100650 and a customizable end effectorportion 100660. The standard connection portion 100650 can include afirst jaw portion 100606 and a second jaw portion 100608. The first jawportion 100606 and the second jaw portion 100608 are rotatable about ajoint 100604.

The customizable end effector portion 100660 can be customized within acustomization region 100602, such that the diameter of the customizationregion 100602 is equal to or less than the diameter D of the shaft ofthe surgical instrument. With the customizable end effector portion100660 being confined to the bounds of the customization region 100602,the surgical end effector 100600 can be inserted through a trocar into apatient's body cavity through minimally invasive surgical procedures.

The customizable end effector portion 100660 can be produced throughvarious additive manufacturing techniques to produce custom geometry andcharacteristics of a first customizable jaw 100612 and a secondcustomizable jaw 100614. Depending on various needs for the surgicalprocedure, the first customizable jaw 100612 and the second customizablejaw 100614 can be modified and adapted to meet the needs of the surgeon.The first customizable jaw 100612 and the second customizable jaw 100614have a plurality of proximal features 100618 and a plurality of distalfeatures 100616. As illustrated in FIG. 829 , the plurality of proximalfeatures 100618 comprises a substantially smooth surface. The pluralityof distal features 100616 comprises a plurality of large distal teeth.The plurality of large distal teeth is only formed on a portion of theinner surfaces of the first customizable jaw 100612 and the secondcustomizable jaw 100614. In addition, the first customizable jaw 100612and the second customizable jaw 100614 comprise external surfacefeatures 100630, 100632, respectively. As illustrated in FIG. 829 , theexternal surface features 100630, 100632 comprise substantially smoothsurfaces. However, in alternative embodiments, the external surfacefeatures 100630, 100632 may comprise teeth, nubs, and/or otherprotrusions to assist with the tissue interaction of the surgical endeffector 100600.

FIG. 830 illustrates a surgical end effector 100700 that is configuredto be modified and adjusted using various manufacturing techniques atthe discretion of a surgeon. The surgical end effector 100700 includes astandard connection portion 100750 and a customizable end effectorportion 100760. The standard connection portion 100750 includes a firstjaw portion 100706 and a second jaw portion 100708. The first jawportion 100706 and the second jaw portion 100708 are rotatable about ajoint 100704.

The customizable end effector portion 100760 can be customized within acustomization region 100702. The diameter of the customization region100702 is equal to or less than the diameter D of the shaft of thesurgical instrument. With the customizable end effector portion 100760being confined to the bounds of the customization region 100702, thesurgical end effector 100700 can be inserted through a trocar into apatient's body cavity through minimally invasive surgical procedures.

The customizable end effector portion 100760 can be produced throughvarious additive manufacturing techniques to produce custom geometry andcharacteristics of a first customizable jaw 100712 and a secondcustomizable jaw 100714. Depending on various requirements for thesurgical procedure, the first customizable jaw 100712 and the secondcustomizable jaw 100714 can be modified and adapted to meet the needs ofthe surgeon. The first customizable jaw 100712 and the secondcustomizable jaw 100714 have a plurality of proximal features 100718 anda plurality of distal features 100716. As illustrated in FIG. 830 , theplurality of proximal features 100718 comprises a substantially smoothsurface. The plurality of distal features 100716 comprises a pluralityof smooth distal teeth. The plurality of smooth distal teeth is onlyformed on a portion of the inner surfaces of the first customizable jaw100712 and the second customizable jaw 100714. In addition, the firstcustomizable jaw 100712 and the second customizable jaw 100714 compriseexternal surface features 100730, 100732, respectively. As illustratedin FIG. 830 , the external surface features 100730, 100732 comprisesubstantially smooth surfaces. However, in alternative embodiments, theexternal surface features 100730, 100732 may comprise teeth, nubs,and/or other protrusions to assist with the tissue interaction of thesurgical end effector 100700.

FIG. 831 illustrates a surgical end effector 100800 that is configuredto be modified and adjusted using various manufacturing techniques atthe discretion of a surgeon. The surgical end effector 100800 includes astandard connection portion 100850 and a customizable end effectorportion 100860. The standard connection portion 100850 can include afirst jaw portion 100806 and a second jaw portion 100808. The first jawportion 100806 and the second jaw portion 100808 are rotatable about ajoint 100804.

The customizable end effector portion 100860 can be customized within acustomization region 100802, such that the diameter of the customizationregion 100802 is equal to or less than the diameter D of the shaft ofthe surgical instrument. With the customizable end effector portion100860 being confined to the bounds of the customization region 100802,the surgical end effector 100800 can be inserted through a trocar into apatient's body cavity through minimally invasive surgical procedures.

The customizable end effector portion 100860 can be produced throughvarious additive manufacturing techniques to produce custom geometry andcharacteristics of a first customizable jaw 100812 and a secondcustomizable jaw 100814. Depending on various requirements for thesurgical procedure, the first customizable jaw 100812 and the secondcustomizable jaw 100814 can be modified and adapted to meet the needs ofthe surgeon. The first customizable jaw 100812 and the secondcustomizable jaw 100814 have a plurality of proximal features 100818 anda plurality of distal features 100816. As illustrated in FIG. 831 , theplurality of proximal features 100818 comprises a substantially smoothsurface. The plurality of distal features 100816 comprises asubstantially smooth surface of low durometer material. The lowdurometer material allows the inner surfaces of the first customizablejaw 100812 and the second customizable jaw 100814 to grasp andmanipulate an object, such as a patient's tissue.

The substantially smooth surface of low durometer material is onlyformed on a portion of the inner surfaces of the first customizable jaw100812 and the second customizable jaw 100814. The substantially smoothsurface can refer to a surface, for example, that is substantially freefrom projections or unevenness, generally flat or unruffled, and/orsubstantially of uniform consistency. In addition, the firstcustomizable jaw 100812 and the second customizable jaw 100814 compriseexternal surface features 100830, 100832, respectively. As illustratedin FIG. 831 , the external surface features 100830, 100832 comprisesubstantially smooth surfaces. However, in alternative embodiments, theexternal surface features 100830, 100832 may comprise teeth, nubs,and/or other protrusions to assist with the tissue interaction of thesurgical end effector 100800.

FIGS. 832 and 833 illustrate another embodiment of a surgical endeffector 100900. The surgical end effector 100900 is configured to bemodified and adjusted using various manufacturing techniques at thediscretion of a surgeon. The surgical end effector 100900 includes astandard connection portion 100950 and a customizable end effectorportion 100960. The standard connection portion 100950 can include afirst jaw portion 100906 and a second jaw portion 100908. The first jawportion 100906 and the second jaw portion 100908 are rotatable about ajoint 100904.

The customizable end effector portion 100960 can be customized withinthe customization region 100902. The diameter of the customizationregion 100902 is equal to or less than the diameter D of the shaft ofthe surgical instrument. With the customizable end effector portion100960 being confined to the bounds of the customization region 100902,the surgical end effector 100900 can be inserted through a trocar into apatient's body cavity through minimally invasive surgical procedures.

The surgical end effector 100900 includes a core/stub portion 100910that is adaptable through additive manufacturing techniques. Thecore/stub portion 100910 provides a base for building and customizingthe geometry and characteristics of a first customizable jaw 100912 anda second customizable jaw 100914. Depending on various needs for thesurgical procedure, the first customizable jaw 100912 and the secondcustomizable jaw 100914 can be modified and adapted to meet the needs ofthe surgeon. The first customizable jaw 100912 and the secondcustomizable jaw 100914 have a plurality of proximal features 100918 anda plurality of distal features 100916. As illustrated in FIG. 833 , theplurality of proximal features 100918 comprises a plurality of proximalteeth. The plurality of distal features 100916 comprises a plurality ofdistal teeth. The plurality of proximal teeth is approximately the sameheight as the plurality of distal teeth. However, in various embodimentsthe plurality of proximal and distal teeth may take variousconfigurations based upon the needs of the surgical procedure, forexample a plurality of symmetrical teeth, a plurality of asymmetricalteeth, and/or a progression from large to small or small to large teeth.

In addition, the first customizable jaw 100912 and the secondcustomizable jaw 100914 have a plurality of features 100930 and 100932,respectively that are positioned on the outer portion of the first andsecond customizable jaws 100912, 100914. As illustrated in FIG. 833 ,the features 100930, 100932 can include ridges, and/or substantiallysmooth surfaces that allow the surgical end effector 100900 to engage,grasp, and/or manipulate an object, for example a patient's tissue.

FIG. 832 depicts a top plan view of the surgical end effector 100900.FIG. 833 depicts a side elevation view of the surgical end effector100900. The overall geometric shape of the surgical end effector 100900is a curved configuration. From the depictions of the surgical endeffector 100900 in FIGS. 832 and 833 , it will be apparent to a personof ordinary skill in the art that the overall profile of the surgicalend effector 100900 has a three dimensional curved geometry.

When selecting the configuration and various features for the surgicalend effector 100900, the external features 100930, 100932, the proximalfeatures 100918, the distal features 100916, the overall geometric shapeof the first and second customizable jaws 100912, 100914, and thematerials used in producing the customizable end effector portion 100960are independent variables that are considered during the customizationprocess. For example, when the surgical end effector 100900 is beingcustomized for a minimally invasive surgical procedure, the variousindependent variables must produce an overall profile of the surgicalinstrument that falls within the customization region 100902 so that thesurgical end effector 100900 can be inserted through a trocar and into apatient's body cavity.

FIGS. 834 and 835 illustrate another embodiment of a surgical endeffector 101000. The surgical end effector 101000 is configured to bemodified and adjusted using various manufacturing techniques at thediscretion of a surgeon. The surgical end effector 101000 includes astandard connection portion 101050 and a customizable end effectorportion 101060. The standard connection portion 101050 can include afirst jaw portion 101006 and a second jaw portion 101008. The first jawportion 101006 and the second jaw portion 101008 are rotatable about ajoint 101004.

The customizable end effector portion 101060 can be customized withinthe customization region 101002. The diameter of the customizationregion 101002 is equal to or less than the diameter D of the shaft ofthe surgical instrument. With the customizable end effector portion101060 being confined to the bounds of the customization region 101002,the surgical end effector 101000 can be inserted through a trocar into apatient's body cavity through minimally invasive surgical procedures.

The surgical end effector 101000 includes a core/stub portion 101010that is adaptable through additive manufacturing techniques. Thecore/stub portion 101010 provides a base for building and customizingthe geometry and characteristics of a first customizable jaw 101012 anda second customizable jaw 101014. Depending on various needs for thesurgical procedure, the first customizable jaw 101012 and the secondcustomizable jaw 101014 can be modified and adapted to meet the needs ofthe surgeon. The first customizable jaw 101012 and the secondcustomizable jaw 101014 have a plurality of proximal features 101018 anda plurality of distal features 101016. As illustrated in FIG. 835 , theplurality of proximal features 101018 comprises a plurality of proximalteeth. The plurality of distal features 101016 comprises a plurality ofdistal teeth. The plurality of proximal teeth is approximately the sameheight as the plurality of distal teeth. However, in various embodimentsthe plurality of proximal and distal teeth may take variousconfigurations based upon the needs of the surgical procedure such as,for example, a plurality of symmetrical teeth, a plurality ofasymmetrical teeth, and/or a progression from large to small or small tolarge teeth.

In addition, the first customizable jaw 101012 and the secondcustomizable jaw 101014 have a plurality of features 101030 a-d and101032 a-d, respectively that are positioned on the outer portion of thefirst and second customizable jaws 101012, 101014. As illustrated inFIG. 835 , the features 101030 a and 101032 a comprise distal concavefeatures. The features 101030 a and 101032 a can have a low durometersurface that is sticky to the touch and can be used to manipulate anobject, such as tissue. In at least one instance, the low-durometerfeatures 101030 a and 101032 a have a durometer between about 15 andabout 70 Shore OO, for example. In certain instances, the low-durometerfeatures 101030 a and 101032 a have a durometer between about 15 andabout 70 Shore A, for example. The features 101030 b and 101032 bcomprise convex protruding features. The features 101030 b and 101032 bcan have a low durometer surface that is sticky to the touch and can beused to manipulate an object, such as tissue. In at least one instance,the low-durometer features 101030 b and 101032 b have a durometerbetween about 15 and about 70 Shore OO, for example. In certaininstances, the low-durometer features 101030 b and 101032 b have adurometer between about 15 and about 70 Shore A, for example. Thefeatures 101030 c and 101032 c comprise concave features. The features101030 c and 101032 c can have a low durometer surface that is sticky tothe touch and can be used to manipulate an object, such as tissue. Thefeatures 101030 d and 101032 d comprise a substantially smooth surface.The features 101030 d and 101032 d can have a low durometer surface thatis sticky to the touch and can be used to manipulate an object, such astissue.

In addition, or in the alternative, various additional configurationsfor the features 101030 a-d and 101032 a-d are possible. The feature101030 a-d and 101032 a-d can include ridges, and/or substantiallysmooth surfaces that allow the surgical end effector 101000 to engage,grasp, and/or manipulate an object, for example a patient's tissue.

FIG. 834 depicts a top plan view of the surgical end effector 101000.FIG. 835 depicts a side elevation view of the surgical end effector101000. The overall geometric shape of the surgical end effector 101000is a substantially linear configuration.

When selecting the configuration and various features for the surgicalend effector 101000, the external features 101030 a-d, 101032 a-d, theproximal features 101018, the distal features 101016, the overallgeometric shape of the first and second customizable jaws 101012,101014, and the materials used in producing the customizable endeffector portion 101060 are independent variables that are consideredduring the customization process. For example, when the surgical endeffector 101000 is being customized for a minimally invasive surgicalprocedure, the various independent variables must produce an overallprofile that falls within the customization region 101002 so that thesurgical end effector 101000 can be inserted through a trocar and into apatient's body cavity.

The various end effectors described above with respect to FIGS. 822-835can be produced through a multi-step process where a first portion ofthe end effector, such as, a standard connection portion, for example,is produced in a manufacturing facility and shipped to hospitals ordistributed to manufacturing hubs. Once the standard connection portionis at its end location, such as a hospital, or at a manufacturingfacility, the standard connection portion can be customized to producean end effector meeting the needs of the user. Such customization canallow surgical end effectors to be produced for specific proceduresand/or specific patients.

The customized end effectors described above with respect to FIGS.822-835 can be produced through various techniques. A clinician canaccess, for example, a dedicated human-machine interface to select anddesign the desired attributes of an end effector. The human-machineinterface can comprise, for example, a graphical user interface of acomputer. The computer can be connected to a manufacturing device. Thecomputer-manufacturing device interface can be wired, wireless, and/orremote, for example, via the internet. When the clinician accesses thehuman-machine interface, they can select the various attributes desiredof the end effector.

When selecting the various attributes of the end effector, the cliniciancan use information gained from the patient or information about theparticular procedure to guide their design of the end effector. When theclinician is using information regarding a particular patient, forexample, the patient's information can come from various patient tests,such as MRIs, X-rays, CT Scans, and/or other medical tests. Thesetesting results can be entered into the computer and used to control thedesign parameters of the end effector. When the clinician uses theresults of an MRI, for example, to detect a patient's tumor, the sizeand shape of the patient's tumor can be used as design parameters whenproducing the customized end effector.

In addition, or in the alternative, the clinician can use parametersfrom the particular surgical procedure to design the customized endeffector. When the end effector is being designed for various bariatricprocedures, for example, the requirements of the specific procedure,such as the size of a gastric bypass reduction, can be used as thedesign parameters when producing the customized end effector.

In selecting the various features for the end effector, the cliniciancan use various software programs to design the desired features of theend effector. The clinician, for example, can input the patient's scansand/or medical test information into the computer and a software programcan determine the design features of the end effector to match thepatient's condition. Once the software program approximates thenecessary features of the end effector, the clinician can review and/ormodify the parameters of the end effector using the human-machineinterface.

In addition, or in the alternative, the clinician can access a softwareprogram using the human-machine interface to design the features of theend effector. The clinician, for example, can access the softwareprogram and select various predetermined shapes, features, and/ordesigns to combine to produce an end effector having the desiredfeatures. The clinician may also use a free-form command in the softwareto freely design the desired features of the end effector.

Once the features of the customized end effector are determined, theclinician and/or manufacturing staff can insert a core/stub portion intoa manufacturing device. The manufacturing device is in communicationwith the human-machine interface of the computer via a wired, wireless,and/or remote internet connection. The clinician, using the softwareprogram, can send the design parameters to the manufacturing device toproduce the end effector.

The manufacturing device can be designed to use various manufacturingprocesses or techniques. The manufacturing device, for example, can be ametal injection molding device, a plastic injection molding device, aCNC machine, an EDM device, a 3-D printing device, and/or various othermanufacturing devices, such as additive manufacturing devices.

After the design parameters are transferred from the computer to themanufacturing device, the software controlling the manufacturing devicecauses the manufacturing device to perform a manufacturing procedure toproduce the customized end effector. The manufacture procedure can addmaterial to the core/stub portion of the end effector. In thealternative, the manufacturing procedure can remove material from thecore/stub portion of the end effector. The manufacturing device can useone or more of the techniques described above in the production of thecustomized end effector. Once the manufacturing device has completed theoverall design and structure of the customized end effector, thecustomized end effector can be finished or polished using a finishingmachine and/or process. The finishing machine may be part of themanufacturing device, or it can be a separate machine/device.

Once the structure of the customized end effector is completed, thecustomized end effector can be tested, cleaned, and/or sterilized. Thetesting process can ensure that the customized end effector is designedto the necessary standards for the particular medical device. Thecleaning process can remove any excess residual material leftover fromthe manufacturing process. The sterilization process can sterilize theend effector so that it can be used in a surgical procedure. After thecustomized end effector is sterilized, it can be packaged for storinguntil it is needed in a surgical procedure or can be used directly by aclinician in a surgical procedure.

A method for producing a customized end effector comprises preparing anend effector connection portion for customization. The end effectorconnection portion comprises a proximal connector configured to attachto a distal end of a surgical instrument. The proximal connectorcomprises an actuator. Once a standard connection portion is prepared,the user determines through interaction with a patient a first desiredcharacteristic of the surgical end effector and a second desiredcharacteristic of the end effector. Once the characteristics of the endeffector are determined, a first jaw member is created on the standardconnection portion having the first desired characteristic. Next, asecond jaw member is created on the standard connection portion havingthe second desired characteristic. The first and second jaw members canbe created through an additive manufacturing process, such as 3-Dprinting.

Surgical instruments can comprise devices that use mechanical energy toperform surgical procedures. Certain end effectors, such as graspingforceps can be used to grasp a target, such as the tissue of a patient,for example. Other end effectors, such as dissectors, for example, canbe used to separate and/or tear the tissue using mechanical forces.Other types of end effectors, such as electrosurgical end effectors, forexample, can use electrosurgical energy to deliver energy to the tissueof a patient and destroy and/or remove targeted tissue. These types ofsurgical instruments have been used independently of one another.

Surgical dissectors, such as the dissectors disclosed in U.S. PatentApplication Publication No. 2010/0198248, entitled SURGICAL DISSECTOR,the disclosure of which is incorporated by reference in its entirety,for example, use mechanical forces and mechanical features on the jawsof the dissector, such as teeth, for example, to manipulate a patient'stissue. The teeth can be used to stretch and/or tear a patient's tissue.Depending on the type and/or amount of tissue that a mechanicaldissector encounters, the mechanical dissector can apply various amountsof mechanical force to the tissue.

Surgical dissectors comprise a pair of jaws that are rotatable betweenopen and closed positions. Each jaw can comprise a plurality offeatures, such as teeth or ridges that can engage a patient's tissue oninner and/or outer surfaces of the jaw, for example. The features, suchas teeth, on the inner surfaces of a pair of surgical dissector jaws canbe used to gasp and/or manipulate tissue when the jaws are closed upon aportion of the patient's tissue. In addition, or in the alternative,when a pair of surgical dissector jaws comprise teeth and/or ridges onouter surfaces thereof, such teeth can increase the traction andinteraction between the jaws and the patient's tissue when the jaws aremoved into an open position, for example. As the pair of surgicaldissector jaws are opened, the teeth on the outer surfaces of the jawscan grip, stretch, and/or tear the tissue.

Electrosurgical devices for applying electrical energy to tissue inorder to treat and/or destroy the tissue are finding increasinglywidespread applications in surgical procedures. An electrosurgicaldevice typically includes a handpiece and an instrument having adistally-mounted end effector (e.g., one or more electrodes). The endeffector can be positioned against the tissue such that electricalcurrent is introduced into the tissue. Electrosurgical devices can beconfigured for bipolar and/or monopolar operation. During bipolaroperation, current is introduced into and returned from the tissue byactive and return electrodes, respectively, of the end effector. Duringmonopolar operation, current is introduced into the tissue by an activeelectrode of the end effector and returned through a return electrode(e.g., a grounding pad) separately located on a patient's body. Heatgenerated by the current flowing through the tissue may form hemostaticseals within the tissue and/or between tissues and thus may beparticularly useful for sealing blood vessels, for example. In someinstances, the voltage and current used ablates the tissue. The endeffector of an electrosurgical device also may include a cutting memberthat is movable relative to the tissue and the electrodes to transectthe tissue.

Electrical energy applied by an electrosurgical device can betransmitted to the instrument by a generator in communication with thehandpiece. The electrical energy may be in the form of radio frequency(RF) energy that may be in a frequency range described in EN60601-2-2:2009+A11:2011, Definition 201.3.218—HIGH FREQUENCY, the entiredisclosure of which is incorporated by reference. In certain instances,the frequencies in monopolar RF applications are typically restricted toless than 5 MHz, for example. However, in bipolar RF applications, thefrequency can be any suitable frequency. Frequencies above 200 kHz canbe typically used for monopolar applications in order to avoid theunwanted stimulation of nerves and muscles which would result from theuse of low frequency current, for instance. Lower frequencies may beused for bipolar techniques if the risk analysis shows the possibilityof neuromuscular stimulation has been mitigated to an acceptable level.Normally, frequencies above 5 MHz are not used in order to minimize theproblems associated with high frequency leakage currents. However,higher frequencies may be used in the case of bipolar techniques. Inmany instances, a minimum of 10 mA is needed to create thermal effectswithin the tissue.

In application, an electrosurgical device can transmit low frequency RFenergy through tissue, which causes ionic agitation, or friction—ineffect resistive heating—thereby increasing the temperature of theaffected tissue. Because a sharp boundary is created between theaffected tissue and the surrounding tissue, a surgeon can operate with ahigh level of precision and control without sacrificing un-targetedadjacent tissue. The low operating temperatures of RF energy is usefulfor removing, shrinking, and/or sculpting soft tissue whilesimultaneously sealing blood vessels. RF energy works particularly wellon connective tissue, which is primarily comprised of collagen andshrinks when contacted by heat.

Other electrical surgical instruments include, without limitation,irreversible and/or reversible electroporation, and/or microwavetechnologies, among others. The techniques disclosed herein areapplicable to ultrasonic, bipolar or monopolar RF (electrosurgical),irreversible and/or reversible electroporation, and/or microwave-basedsurgical instruments, among others. U.S. Patent Application PublicationNo. 2017/0086914, entitled TECHNIQUES FOR OPERATING GENERATOR FORDIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICALINSTRUMENTS provides examples of electrosurgical instruments andelectrosurgical generators that can be used with the instrumentsdescribed herein, the disclosure of which is incorporated by referencein its entirety.

FIGS. 836-843 illustrate surgical instruments that comprise themechanical features of surgical dissectors and the electrosurgicalfeatures of electrosurgical devices. The combination of surgicaldissector and electrosurgical instrument can allow the surgicalinstruments illustrated in FIGS. 836-843 to perform various surgicalprocedures. In addition, the combination of the mechanical andelectrosurgical features may allow a surgeon to perform a surgicalprocedure without having to switch between different surgicalinstruments. As discussed in greater detail below with respect to FIG.844 , the combination of a mechanical dissector and an electrosurgicalinstrument can provide synergistic effects and improve the overallefficiencies and abilities of surgical end effectors.

The embodiments disclosed in FIGS. 836-843 illustrate various endeffector jaws comprising mechanical dissector features andelectrosurgical device features. These end effector jaws can be usedwith surgical instruments to deliver mechanical as well as electricalenergy to a patient's tissue. The surgical instruments can compriseproximal and distal end effector portions. The proximal portion mayinclude a user interface, such as a handle portion and/or a connectorthat can connect the surgical instrument to a robotic system, forexample. The distal portion of the surgical instruments can comprise asurgical end effector. The surgical end effector can comprise a pair ofjaws that are rotatable between open and closed positions. Theembodiments disclosed in FIGS. 836-843 illustrate an end effector jawthat can be used in a pair of jaws of a surgical end effector.

FIGS. 836-839 illustrate a surgical end effector jaw 101100 comprising aframe 101102, a metallic core 101130, and a covering 101126. The endeffector jaw 101100 comprises an inner surface 101118 and an outersurface 101108. When the end effector jaw 101100 is used in a pair ofjaws of a surgical instrument, the inner surfaces 101118 of the endeffector jaws 101100 are positioned adjacent one another. The outersurfaces, 101108 of the end effector jaw 101100 are positioned onopposite sides of the end effector jaw 101100.

The frame 101102 of the surgical end effector jaw 101100 comprises asocket 101104. When the end effector jaw 101100 is used in a pair ofjaws of a surgical instrument, the sockets 101104 of the two endeffector jaws 101100 are aligned and a pin can be inserted through thesockets 101104. The pair of end effector jaws 101100 can be rotatedabout the pin between open and closed positions. The surgical instrumentcan also comprise an actuator that can move the end effector jaws 101100between open and closed positions.

The surgical end effector jaw 101100 comprises a proximal portion 101106and a distal portion 101110. The overall geometry of the end effectorjaw 101100 is curved between the proximal portion 101106 and the distalportion 101110. In addition, the end effector jaw 101100 is tapered fromthe wider proximal portion 101106 to the narrower distal portion 101110.The tapered profile of the end effector jaw 101100 can permit a surgeonto target a specific location within a patient.

In addition, or in the alternative, the surgical end effector jaw 101100can comprise other geometries, such as a symmetrical geometry and/or anda tapered geometry with a larger distal portion 101110 and a narrowerproximal portion 101106, for example. When the surgical end effector jaw101100 comprises a symmetrical profile, the surgical end effector jaw101100 can grasp a patient's tissue evenly over the entire end effectorjaw 101100. When the surgical end effector jaw 101100 comprises atapered geometry with a larger distal portion 101110 and a narrowerproximal portion 101106, the larger distal portion 101110 can allow thesurgical end effector 101100 to grasp a larger portion of the patient'stissue.

The proximal portion 101106 of the outer surface 101108 comprises asubstantially smooth surface. The substantially smooth surface can referto a surface, for example, that is substantially free from projectionsor unevenness, generally flat or unruffled, and/or substantially ofuniform consistency. The distal portion 101110 of the outer surface101108 comprises a plurality of features. The plurality of featurescomprises central features 101120, peripheral features 101122, andlateral features 101132, and/or any other suitable features.

The central features 101120, peripheral features 101122, and lateralfeatures 101132 comprise ridges, or teeth, but could comprise anysuitable configuration. The central features 101120, peripheral features101122, and lateral features 101132 can be comprised of variousmaterials. The central, peripheral, and/or lateral features 101120,101122, 101132 can be comprised of a first material and the outersurface 101108 of the end effector jaw 101100 can be comprised of asecond material. The first material can have a greater elasticity thanthe second material. The second material can have a greater rigiditythan the first material. With a less rigid and more elastic material,the central, peripheral, and/or lateral features 101120, 101122, 101132can deform against a target, such as a patient's tissue, and increasethe traction and interaction between the surgical end effector jaw101100 and the target object.

The plurality of central features 101120 can be substantiallyperpendicular to the chord of the arc of the jaw 101108. The pluralityof central features 101120 are raised above the outer surface of the jaw101108. In addition, the central features 101120 can be overlaid orovermolded with the lateral features 101132 that can be positioned alongthe jaw 101108. The lateral features 101132 can be comprised of adifferent material having a different rigidity and elasticity. Forinstance, the lateral features 101132 can be more elastic and/or havegreater compliance than the central features 101120 which can allow thelateral features 101132 to have a greater ability to interact with atarget, such as a patient's tissue. The plurality of central features101120 can have a slight concavity with respect to the proximal portion101106 of the end effector jaw 101100, for example. The plurality ofperipheral features 101122 can include a convex shape with respect tothe proximal portion 101106 of the end effector jaw 101100, for example.The convex-concave-convex pattern of the peripheral-central-peripheralfeature combination can allow for greater interaction with a target,such as a patient's tissue.

Where the central features 101120 are aligned substantiallyperpendicular to the chord of the arc on the surgical end effector jaw101100, the central features 101120 can facilitate a desired interactionwith a patient's tissue. This configuration may allow the surgical endeffector jaw 101100 to be drawn through the tissue plane and create aparting action of the tissue. Furthermore, where the patterns of thecentral features 101120 at the tip of the surgical instrument arealigned with the chord of the arc of the surgical end effector jaw101100, this pattern facilitates the lateral movement of the surgicalend effector jaw 101100 to create a tissue parting action.

The central, peripheral, and lateral features 101120, 101122, 101132 ofthe end effector jaw 101100 can include symmetrical or asymmetricalpatterns that extend along the end effector jaw 101100. The patterns ofthe central, peripheral, and/or lateral features 101120, 101122, 101132can be continuous or interlocking and become more interrupted andstaggered as they extend towards the proximal portion 101106 and/ordistal portion 101110 of the end effector jaw 101100. The variousconfigurations of the central, peripheral, and lateral features 101120,101122, 101132 can result in posts or standing pillars that can enhancethe interaction of these features with the target object, such as apatient's tissue.

The central, peripheral, and lateral features 101120, 101122, 101132 cancomprise overmolded plastic and/or polymers. The central, peripheral,and lateral features 101120, 101122, 101132 can comprise variouspolymers or plastics having different densities and/or properties. Afirst layer of plastic may be overmolded onto portions of the metalliccore 101130 of the end effector jaw 101100. The first layer of plasticcan have a first density, rigidity, and elasticity. A second layer ofplastic may be overmolded onto portions of the first layer of overmoldedplastic and/or onto portions of the metallic core 101130. The secondlayer of plastic can have a second density, rigidity, and elasticity.The first density, rigidity, and/or elasticity can be the same ordifferent than the second density, rigidity and/or elasticity.

Various sections of the covering 101126 can comprise overmolded plasticand/or polymers. The various sections of the covering 101126 cancomprise various polymers or plastics having different densities and/orproperties. A first layer of plastics may be overmolded onto portions ofthe metallic core 101130 of the end effector jaw 101100. The first layerof plastic can have a first density, rigidity, and elasticity. A secondlayer of plastic may be overmolded onto portions of the first layer ofovermolded plastic and/or onto portions of the metallic core 101130. Thesecond layer of plastic can have a second density, rigidity, andelasticity. The first density, rigidity, and/or elasticity can be thesame or different than the second density, rigidity and/or elasticity.

In one embodiment, the first layer can comprise a rigid layer that canprovide a structural support or backbone to the end effector jaw 101100along with the metallic core 101130. The second layer can comprise amore elastic and/or less rigid layer. The second layer can be moredeformable to create a tissue interaction outer surface that allows forgrasping and securing the tissue. The first layer that is more rigid canhave a sharper profile and edges that can maintain its shape andactively shear tissue while the outer softer layer acts more like abumper to prevent cutting tissue before the surgical end effector jaw101100 is engaged with the desired location or section of tissue.

The inner surface 101118 of the end effector jaw 101100 comprises aplurality of teeth 101116 that extend between the proximal portion101106 and the distal portion 101110 of the end effector jaw 101100. Theplurality of teeth 101116 extend across the width of the inner surface101118 and follow the tapered profile of the end effector jaw 101100.The central portion of the plurality of teeth 101116 comprises anexposed section of the metallic core 101130. The exposed section of themetallic core 101130 extends substantially uniformly down the centralportion of the plurality of teeth 10116 between the proximal portion101106 and the distal portion 101110. In the alternative, the metalliccore 101130 can extend to the inner surface 101118 of the end effectorjaw 101100, for example, in an asymmetrical pattern. The differentexposed patterns of the metallic core 101130 can allow the end effectorjaw 101100 to transmit electrosurgical energy to a patient's tissue indifferent ways, as described in greater detail below.

When a patient's tissue comes in contact with the metallic core 101130,a surgeon can apply electrosurgical energy to the targeted tissuethrough the metallic core 101130. The electrosurgical energy can causeablation and/or cauterization of the targeted tissue.

The distal most portion of the inner surface 101118 comprises a distalbumper portion 101124 and a distal tip 101128. The distal bumper portion101124 comprises an elastic and/or deformable material that can allowthe end effector jaw 101100 to interact with a target object with lessirritation to the object. The distal tip 101128 comprises the metalliccore 101130 and is configured to deliver electrosurgical energy to atarget object, such as a patient's tissue. The distal bumper portion101124 being constructed of a more elastic and less rigid material canallow the user of the surgical end effector jaw 101100 to be moreaggressive without increasing the irritation of the target object, suchas a patient's tissue.

In addition, or in the alternative, the various polymers and/or plasticsthat comprise the surgical end effector jaw 101100 may comprisehydrophobic plastic or materials. The hydrophobic materials can repelliquid, such as body fluids and/or water to keep the dissection featuresfree to dissect. In addition, by repelling fluids, the hydrophobicmaterial may allow a user greater visibility of the interaction portionsof the device when using the device in a minimally invasive procedure.The hydrophobic materials may also allow for a consistent dissectionsurface during the use of the surgical instrument by repelling andkeeping away the fluids from the interaction site.

FIGS. 840-842 illustrate a surgical end effector jaw 101200 comprising aframe 101202, a metallic core 101230, and a covering 101226. The endeffector jaw 101200 comprises an inner surface 101218 and an outersurface 101208. When the end effector jaw 101200 is used in a pair ofjaws of a surgical instrument, the inner surfaces 101218 of the endeffector jaws 101200 are positioned adjacent one another. The outersurfaces 101208 of the end effector jaw 101200 are positioned onopposite sides of the end effector jaw 101200.

The frame 101202 of the surgical end effector jaw 101200 comprises asocket 101204. When the end effector jaw 101200 is used in a pair ofjaws of a surgical instrument, the sockets 101204 of the two endeffector jaws 101200 are aligned and a pin can be inserted through thesockets 101204. The pair of end effector jaws 101200 can be rotatedabout the pin between open and closed positions. The surgical instrumentcan also comprise an actuator that can move the end effector jaws 101200between open and closed positions.

The surgical end effector jaw 101200 comprises a proximal portion 101206and a distal portion 101210. The overall geometry of the end effectorjaw 101200 is curved between the proximal portion 101206 and the distalportion 101210. In addition, the end effector jaw 101200 is tapered fromthe wider proximal portion 101206 to the narrower distal portion 101210.The tapered profile of the end effector jaw 101200 can permit a surgeonto target a specific location within a patient.

In addition, or in the alternative, the surgical end effector jaw 101200can comprise other geometries, such as a symmetrical geometry and/or anda tapered geometry with a larger distal portion 101210 and a narrowerproximal portion 101206, for example. When the surgical end effector jaw101200 comprises a symmetrical profile, the surgical end effector jaw101200 can grasp a patient's tissue evenly over the entire end effectorjaw 101200. When the surgical end effector jaw 101200 comprises atapered geometry with a larger distal portion 101210 and a narrowerproximal portion 101206, the larger distal portion 101210 can allow thesurgical end effector 101200 to grasp a larger portion of the patient'stissue.

The proximal portion 101206 of the outer surface 101208 comprises asubstantially smooth surface. The substantially smooth surface can referto a surface, for example, that is substantially free from projectionsor unevenness, generally flat or unruffled, and/or substantially ofuniform consistency. The distal portion 101210 of the outer surface101208 comprises a plurality of features. The plurality of featurescomprises central features 101220, peripheral features 101222, andlateral features 101232, and/or any other suitable features.

The central features 101220, peripheral features 101222, and lateralfeatures 101232 comprise recesses or through holes, but could compriseany suitable configuration. The recesses or through holes expose themetallic core 101230 to the outer surface 101208 and patient tissue. Thecentral features 101220, peripheral features 101122, and lateralfeatures 101232 can comprise different diameters and/or depths, or thesame diameters and/or depths. The central features 101220, peripheralfeatures 101122, and lateral features 101232 can also comprise differentpatterns and/or orientations along the outer surface 101208 of thesurgical end effector jaw 101200.

The central features 101220, peripheral features 101222, and lateralfeatures 101232 allow a patient's tissue to come in contact with themetallic core 101230 of the surgical end effector jaw 101200. When apair of end effector jaws 101200 is used to stretch out tissue, themechanical forces used to stretch out the tissue can cause the tissue toflow into the central features 101220, peripheral features 101222,and/or lateral features 101232. Once the tissue is in contact with themetallic core 101230 within the central features 101220, peripheralfeatures 101222, and/or lateral features 101232, a clinician can applyelectrosurgical energy to the tissue. The combination of mechanicalforce and electrosurgical energy can allow for ablation of the tissuewithout tearing the tissue. In addition, or in the alternative, theelectrosurgical energy can allow the end effector jaws 101200 tocauterize the tissue as the tissue is spread and/or torn. Thecombination of electrosurgical energy and mechanical forces can allow asurgeon to perform a surgical procedure with using less mechanical forceas the effects of the electrosurgical energy and mechanical force arecumulative.

In various instances, less mechanical force, for example, is required todissect tissue when more electrosurgical energy is applied.Correspondingly, more mechanical force is required to dissect tissuewhen less electrosurgical energy is applied. That said, the ratio ofmechanical force to electrosurgical energy can be held constantthroughout the opening stroke of the dissector jaws. In other instances,the ratio of mechanical force to electrosurgical energy can changethroughout the opening stroke of the dissector jaws. In at lease oneinstance, the electrosurgical energy can increase as the dissector jawsare opened. Such an arrangement can apply the electrosurgical energywhen tissue tearing and/or bleeding is most likely to occur. In otherinstances, the electrosurgical energy can decrease as the dissector jawsare opened. Such an arrangement can create or start an initial otomythat then is stretched open by the mechanical force.

The inner surface 101218 of the end effector jaw 101200 comprises aplurality of teeth 101216 that extend between the proximal portion101206 and the distal portion 101210 of the end effector jaw 101200. Theplurality of teeth 101216 extend across the width of the inner surface101218 and follow the tapered profile of the end effector jaw 101200.The central portion of the plurality of teeth 101216 comprises anexposed section of the metallic core 101230. The exposed section of themetallic core 101230 extends substantially uniformly down the centralportion of the plurality of teeth 10126 between the proximal portion101206 and the distal portion 101210. In the alternative, the metalliccore 101230 can extend to the inner surface 101218 of the end effectorjaw 101200, for example, in an asymmetrical pattern. The differentexposed patterns of the metallic core 101230 can allow the end effectorjaw 101200 to transmit electrosurgical energy to a patient's tissue indifferent ways, as described in greater detail below.

When a patient's tissue comes in contact with the metallic core 101230,a surgeon can apply electrosurgical energy to the targeted tissuethrough the metallic core 101230. The electrosurgical energy can causeablation and/or cauterization of the targeted tissue.

The distal most portion of the inner surface 101218 comprises a distalbumper portion 101224 and a distal tip 101228. The distal bumper portion101224 comprises an elastic and/or deformable material that can allowthe end effector jaw 101200 to interact with a target object with lessirritation to the object. The distal tip 101228 comprises the metalliccore 101230 and is configured to deliver electrosurgical energy to atarget object, such as a patient's tissue. The distal bumper portion101224 being constructed of a more elastic and less rigid material canallow the user of the surgical end effector jaw 101200 to be moreaggressive without increasing the irritation of the target object, suchas a patient's tissue.

Various sections of the covering 101226 can comprise overmolded plasticand/or polymers. The various sections of the covering 101226 cancomprise various polymers or plastics having different densities and/orproperties. A first layer of plastics may be overmolded onto portions ofthe metallic core 101230 of the end effector jaw 101200. The first layerof plastic can have a first density, rigidity, and elasticity. A secondlayer of plastic may be overmolded onto portions of the first layer ofovermolded plastic and/or onto portions of the metallic core 101230. Thesecond layer of plastic can have a second density, rigidity, andelasticity. The first density, rigidity, and/or elasticity can be thesame or different than the second density, rigidity and/or elasticity.

In addition, or in the alternative, the various polymers and/or plasticsthat comprise the surgical end effector jaw 101200 may comprisehydrophobic plastic or materials. The hydrophobic materials can repelliquid, such as body fluids and/or water to keep the dissection featuresfree to dissect. In addition, by repelling fluids, the hydrophobicmaterial may allow a user greater visibility of the interaction portionsof the device when using the device in a minimally invasive procedure.The hydrophobic materials may also allow for a consistent dissectionsurface during the use of the surgical instrument by repelling andkeeping away the fluids from the interaction site.

FIG. 843 illustrates an embodiment similar to the end effector 101300,discussed above. The end effector 101300 includes a central distalfeature 101336 and lateral distal features 101334 that are positioned onthe distal nose of the end effector jaw 101300. The central distalfeature 101336 and lateral distal features 101334 comprise recesses orthrough holes. The recesses or through holes expose the metallic core101330 to the outer surface 101308. The central distal feature 101336and lateral distal features 101334 can comprise different diametersand/or depths, or the same diameters and/or depths. The central distalfeature 101336 and lateral distal features 101334 can also comprisedifferent patterns and/or orientations along the outer surface 101308 ofthe surgical end effector jaw 101300.

The central distal feature 101336 and lateral distal features 101334allow a patient's tissue to come in contact with the metallic core101330 of the surgical end effector jaw 101300. When a surgeon pushestissue with the nose of the surgical end effector jaw 101300, themechanical forces used to push the jaw 101300 into the tissue to stretchout the tissue can cause the tissue to flow into the central distalfeature 101336 and lateral distal features 101334. Once the tissue is incontact with the metallic core 101330 within the central distal feature101336 and/or lateral distal features 101334, electrosurgical energy canbe transmitted to the tissue. The combination of mechanical force andelectrosurgical energy can allow for ablation of the tissue withouttearing the tissue. In addition, or in the alternative, theelectrosurgical energy can allow the end effector jaws 101300 tocauterize the tissue as the tissue is spread and/or torn. Thecombination of electrosurgical energy and mechanical forces can allow asurgeon to perform a surgical procedure with using less mechanical forceas the effects of the electrosurgical energy and mechanical force arecumulative.

In various instances, less mechanical force, for example, is required todissect tissue when more electrosurgical energy is applied.Correspondingly, more mechanical force is required to dissect tissuewhen less electrosurgical energy is applied. That said, the ratio ofmechanical force to electrosurgical energy can be held constantthroughout the opening stroke of the dissector jaws. In other instances,the ratio of mechanical force to electrosurgical energy can changethroughout the opening stroke of the dissector jaws. In at lease oneinstance, the electrosurgical energy can increase as the dissector jawsare opened. Such an arrangement can apply the electrosurgical energywhen tissue tearing and/or bleeding is most likely to occur. In otherinstances, the electrosurgical energy can decrease as the dissector jawsare opened. Such an arrangement can create or start an initial otomythat then is stretched open by the mechanical force.

The surgical end effector jaws may also have overmolded plastic bodieshaving fractal exterior geometries. The fractal exterior geometries canenable the distal tip of the end effector jaws to be more aggressivewithout creating undesired interaction with the tissue. In anotherembodiment, the metallic core of the end effector jaws can be positionednear the outer surface and at the distal tip as well as along the spineof the surgical end effector, as seen in FIGS. 840-843 . The metalliccore may be exposed to the tissue through the various features andrecesses along the end effector jaw's outer surface. The metallic coremay be recessed within 0.0001-0.001 mm of the outer surface and inelectrical contact with the shaft of the surgical instrument to permitthe transmission of electrosurgical energy along the end effector jaw.With the metallic core exposed to the tissue, the metallic core candeliver electrosurgical energy to the patient's tissue. In thisconfiguration, the surgical instrument may operate as a hybrid between amechanical surgical dissector and an electrosurgical instrument.

The various features and characteristics described with regard to thesurgical instruments and end effectors illustrated in FIGS. 822-843 canbe comprised of various materials. The end effectors illustrated inFIGS. 836-843 can comprise a metallic core that can deliverelectrosurgical energy from an electrosurgical instrument to a patient'stissue. The various features described above can comprise overmoldedplastic or polymers. The features can comprise polymers or plasticshaving various densities and properties. A first layer of plastics maybe overmolded onto portions of the metallic core of the end effector.The first layer of plastic can have a first density, rigidity, andelasticity. A second layer of plastics may be overmolded onto portionsof the first layer of overmolded plastic and/or onto portions of themetallic core. The second layer of plastic can have a second density,rigidity, and elasticity. The first density, rigidity and/or elasticitycan be the same or different than the second density, rigidity and/orelasticity.

In one embodiment, the first layer can comprise a rigid layer that canprovide a structural support or backbone to the end effector. The secondlayer can comprise a more elastic and less rigid layer. The second layercan be more deformable to create a tissue interaction outer surface thatallows for grasping and securing the tissue. The first layer that ismore rigid can have a sharper profile and edges that can maintain itsshape and actively shear tissue while the outer softer layer acts morelike a bumper to prevent cutting tissue before the surgical end effectoris engaged with the desired portion or section of tissue.

The surgical instruments illustrated in FIGS. 836-843 can be producedthrough traditional manufacturing processes. In addition, or in thealternative, the surgical instruments illustrated in FIGS. 836-843 canbe produced through the additive manufacturing procedures discussedabove with respect to FIGS. 822-835 . The surgical instruments of FIGS.836-843 can comprise a metallic core and the outer shape and features ofthe end effectors can be produced through an additive manufacturingprocess to produce customized surgical end effectors having desiredfeatures and/or shapes.

As discussed above, with regard to FIGS. 836-843 , surgical end effectorjaws can be used to employ a combination of electrosurgical andmechanical forces to effected tissue. FIG. 844 illustrates a graphicalrepresentation 101400 of the relationship between various parameters fora surgical instrument having mechanical and electrosurgical features.The various parameters include the current delivered to the tissue101402, the voltage to current ratio 101404, the impedance of the tissuebeing treated 101406, and the mechanical force being applied to thetissue 101408. The various parameters are illustrated with a referenceto various aspects of a surgical procedure, such as a dissectionprocedure 101410, for example. The dissection procedure 101410 includesan initial force loading condition 101412, a tissue spreading condition101414, and a force unloading condition 101416.

During the initial force loading condition 101412, the current deliveredto the tissue 101402, the voltage to current ratio 101404, and theimpedance of the tissue being treated 101406 initially increase. Overthe initial force loading condition 101412, the current delivered to thetissue 101402 and the voltage to current ratio 101404 continue toincrease while the impedance of the tissue being treated 101406decreases and then levels out. The mechanical force being applied to thetissue 101408 also increases over the initial force loading condition101412. As the mechanical force being applied to the tissue 101408increase, the surgical end effector jaws begin to push layers of thetissue away.

Once the initial force loading condition 101412 is completed, the tissuespreading condition 101414 occurs. Over a first stage of the tissuespreading condition 101414, the current delivered to the tissue 101402and the impedance of the tissue being treated 101406 remain relativelysteady while the voltage to current ratio 101404 fluctuates. Inaddition, over the first stage of the tissue spreading condition 101414,the mechanical force being applied to the tissue 101408 increases andbegins to exceed a higher reinforcement threshold. When the higherreinforcement threshold is exceeded, the current delivered to the tissue101402 and the voltage to current ratio 101404 are increased toreinforce the tissue spreading, which in turn reduces the impedance ofthe tissue being treated 101406. The mechanical force being applied tothe tissue 101408 by the end effector jaws drop due to the assistance ofthe electrosurgical energy, as such, the levels for the currentdelivered to the tissue 101402 and the voltage to current ratio 101404are reduced. When the mechanical force being applied to the tissue101408 falls below a lower reinforcement threshold, the currentdelivered to the tissue 101402 and the voltage to current ratio 101404are reduced as the need for reinforcement assistance from theelectrosurgical aspects of the surgical instrument are reduced. Once themechanical force being applied to the tissue 101408 climbs above thelower reinforcement threshold, the current delivered to the tissue101402 and the voltage to current ratio 101404 return to their previouslevels.

After the tissue spreading condition 101414 occurs, the mechanicalforces and electrosurgical energy being applied are reduced asrepresented by the unloading condition 101416. During the forceunloading condition 101416, the current delivered to the tissue 101402,the voltage to current ratio 101404, the impedance of the tissue beingtreated 101406, and the mechanical force being applied to the tissue101408 are all reduced to the initial unloaded condition. Thecombination of the mechanical force being applied to the tissue 101408and electrosurgical energy allows the surgical instrument to perform thesurgical procedure using less mechanical energy which can result in lesstearing of the tissue. The application of the electrosurgical energy canalso seal the tissue as it is being separated by the opening of the endeffector jaws.

To detect the various threshold levels, discussed above, a surgicalinstrument may have sensors to monitor the pressures, currents,voltages, impedance of the tissue, and forces applied during a surgicalprocedure and modify the parameters to prevent any of the threshold frombeing exceeded. In addition, or in the alternative, a surgeon may beprovided with tactical feedback regarding the parameters and manuallycontrol the various parameters.

A surgical system 128000 is illustrated in FIG. 844 . The surgicalsystem 128000 comprises a handle, a shaft 128020 extending from thehandle, and an end effector 128030 extending from the shaft 128020. Inalternative embodiments, the surgical system 128000 comprises a housingconfigured to be mounted to a robotic surgical system. In at least onesuch embodiment, the shaft 128020 extends from the robotic housing mountinstead of the handle. In either event, the end effector 128030comprises jaws 128040 and 128050 which are closeable to grasp a target,such as the tissue T of a patient and/or a suture needle, for example,as discussed in greater detail below. The jaws 128040 and 128050 arealso openable to dissect the tissue of a patient, for example. In atleast one instance, the jaws 128040 and 128050 are insertable into thepatient tissue to create an otomy therein and then spread to open theotomy, as discussed in greater detail below.

Referring again to FIG. 844 , the jaws 128040 and 128050 are pivotablycoupled to the shaft 128020 about a pivot joint 128060. The pivot joint128060 defines a fixed axis of rotation, although any suitablearrangement could be used. The jaw 128040 comprises a distal end, ortip, 128041 and an elongate profile which narrows from its proximal endto its distal end 128041. Similarly, the jaw 128050 comprises a distalend, or tip, 128051 and an elongate profile which narrows from itsproximal end to its distal end 128051. The distance between the tips128041 and 128051 define the mouth width, or opening, 128032 of the endeffector 128030. When the tips 128041 and 128051 are close to oneanother, or in contact with one another, the mouth 128032 is small, orclosed, and the mouth angle θ is small, or zero. When the tips 128041and 128051 are far apart, the mouth 128032 is large and the mouth angleθ is large.

Further to the above, the jaws of the end effector 128030 are driven bya jaw drive system including an electric motor. In use, a voltagepotential is applied to the electric motor to rotate the drive shaft ofthe electric motor and drive the jaw drive system. The surgical system128000 comprises a motor control system configured to apply the voltagepotential to the electric motor. In at least one instance, the motorcontrol system is configured to apply a constant DC voltage potential tothe electric motor. In such instances, the electric motor will run at aconstant speed, or an at least substantially constant speed. In variousinstances, the motor control system comprises a pulse width modulation(PWM) circuit and/or a frequency modulation (FM) circuit which can applyvoltage pulses to the electric motor. The PWM and/or FM circuits cancontrol the speed of the electric motor by controlling the frequency ofthe voltage pulses supplied to the electric motor, the duration of thevoltage pulses supplied to the electric motor, and/or the durationbetween the voltage pulses supplied to the electric motor.

The motor control system is also configured to monitor the current drawnby the electric motor as a means for monitoring the force being appliedby the jaws of the end effector 128030. When the current being drawn bythe electric motor is low, the loading force on the jaws is low.Correspondingly, the loading force on the jaws is high when the currentbeing drawn by the electric motor is high. In various instances, thevoltage being applied to the electric motor is fixed, or held constant,and the motor current is permitted to fluctuate as a function of theforce loading at the jaws. In certain instances, the motor controlsystem is configured to limit the current drawn by the electric motor tolimit the force that can be applied by the jaws. In at least oneembodiment, the motor control system can include a current regulationcircuit that holds constant, or at least substantially constant, thecurrent drawn by the electric motor to maintain a constant loading forceat the jaws.

The force generated between the jaws of the end effector 128030, and/oron the jaws of the end effector 128030, may be different depending onthe task that the jaws are being used to perform. For instance, theforce needed to hold a suture needle may be high as suture needles aretypically small and it is possible that a suture needle may slip duringuse. As such, the jaws of the end effector 128030 are often used togenerate large forces when the jaws are close together. On the otherhand, the jaws of the end effector 128030 are often used to applysmaller forces when the jaws are positioned further apart to performlarger, or gross, tissue manipulation, for example.

Referring to the upper portion 128110 of the graph 128100 illustrated inFIG. 845 , the loading force, f, experienced by the jaws of the endeffector 128030 can be limited by a force profile stored in the motorcontrol system. The force limit profile 128110 o for opening the jaws128040 and 128050 is different than the force limit profile 128110 c forclosing the jaws 128040 and 128050. This is because the proceduresperformed when forcing the jaws 128040 and 128050 open are typicallydifferent than the procedures performed when forcing the jaws 128040 and128050 closed. That said, the opening and closing force limit profilescould be the same. While it is likely that the jaws 128040 and 128050will experience some force loading regardless of whether the jaws 128050are being opened or closed, the force limit profiles typically come intoplay when the jaws 128040 and 128050 are being used to perform aparticular procedure within the patient. For instance, the jaws 128040and 128050 are forced open to create and expand an otomy in the tissueof a patient, as represented by graph sections 128115 and 128116,respectively, of graph 128100, while the jaws 128040 and 128050 areforced closed to grasp a needle and/or the patient tissue, asrepresented by graph sections 128111 and 128112, respectively, of graph128100.

Referring again to FIG. 845 , the opening and closing jaw force limitprofiles 128110 o and 128110 c, respectively, are depicted on theopposite sides of a zero force line depicted in the graph 128100. As canbe seen in the upper section 128110 of graph 128100, the jaw force limitthreshold is higher—for both force limit profiles 128110 o and 128110c—when the jaws 128040 and 128050 are just being opened from theirfully-closed position. As can also be seen in the upper section 128110of graph 128100, the jaw force limit threshold is lower—for both forcelimit profiles 128110 o and 128110 c—when the jaws 128040 and 128050 arereaching their fully-opened position. Such an arrangement can reduce thepossibility of the jaws 128040 and 128050 damaging adjacent tissue whenthe being fully opened, for example. In any event, the force that thejaws 128040 and 128050 are allowed to apply is a function of the mouthopening size between the jaws and/or the direction in which the jaws arebeing moved. For instance, when the jaws 128040 and 128050 are openedwidely, or at their maximum, to grasp large objects, referring to graphsection 128114 of upper graph section 128110, the jaw force f limit isvery low as compared to when the jaws 128040 and 128050 are more closedto perform gross tissue manipulation, referring to graph section 128113of upper graph section 128110. Moreover, different jaw force limitprofiles can be used for different jaw configurations. For instance,Maryland dissectors, which have narrow and pointy jaws, may have adifferent jaw force limit profile than a grasper having blunt jaws, forexample.

In addition to or in lieu of the above, the speed of the jaws 128040 and128050 can be controlled and/or limited by the motor control system as afunction of the mouth opening size between the jaws 128040 and 128050and/or the direction the jaws are being moved. Referring to the middleportion 128120 and lower portion 128130 of the graph 128100 in FIG. 845, the rate limit profile for moving the jaws 128040 and 128050 permitsthe jaws to be moved slowly when the jaws are near their closed positionand moved quickly when the jaws are near their open position. In suchinstances, the jaws 128040 and 128050 are accelerated as the jaws areopened. Such an arrangement can provide fine control over the jaws128040 and 128050 when they are close together to facilitate the finedissection of tissue, for example. Notably, the rate limit profile foropening and closing the jaws 128040 and 128050 is the same, but theycould be different in other embodiments. In alternative embodiments, therate limit profile for moving the jaws 128040 and 128050 permits thejaws to be moved quickly when the jaws are near their closed positionand slowly when the jaws are near their open position. In suchinstances, the jaws 128040 and 128050 are decelerated as the jaws areopened. Such an arrangement can provide fine control over the jaws128040 and 128050 when the jaws are being used to stretch an otomy, forexample. The above being said, the speed of the jaws 128040 and 128050can be adjusted once the jaws experience loading resistance from thepatient tissue, for example. In at least one such instance, the jawopening rate and/or the jaw closing rate can be reduced once the jaws128040 and 128050 begin to experience force resistance above athreshold, for example.

In various instances, further to the above, the handle of the surgicalsystem 128000 comprises an actuator, the motion of which tracks, or issupposed to track, the motion of the jaws 128040 and 128050 of the endeffector 128030. For instance, the actuator can comprise a scissors-gripconfiguration which is openable and closable to mimic the opening andclosing of the end effector jaws 128040 and 128050. The control systemof the surgical system 128000 can comprise one or more sensor systemsconfigured to monitor the state of the end effector jaws 128040 and128050 and the state of the handle actuator and, if there is adiscrepancy between the two states, the control system can take acorrective action once the discrepancy exceeds a threshold and/orthreshold range. In at least one instance, the control system canprovide feedback, such as audio, tactile, and/or haptic feedback, forexample, to the clinician that the discrepancy exists and/or provide thedegree of discrepancy to the clinician. In such instances, the cliniciancan make mental compensations for this discrepancy. In addition to or inlieu of the above, the control system can adapt its control program ofthe jaws 128040 and 128050 to match the motion of the actuator. In atleast one instance, the control system can monitor the loading forcebeing applied to the jaws and align the closed position of the actuatorwith the position of the jaws when the jaws experience the peak forceloading condition when grasping tissue. Similarly, the control systemcan align the open position of the actuator with the position of thejaws when the jaws experience the minimum force loading condition whengrasping tissue. In various instances, the control system is configuredto provide the clinician with a control to override these adjustmentsand allow the clinician to use their own discretion in using thesurgical system 128000 in an appropriate manner.

A surgical system 128700 is illustrated in FIGS. 846 and 847 . Thesurgical system 128700 comprises a handle, a shaft assembly 128720extending from the handle, and an end effector 128730 extending from theshaft assembly 128720. In alternative embodiments, the surgical system128700 comprises a housing configured to be mounted to a roboticsurgical system. In at least one such embodiment, the shaft 128720extends from the robotic housing mount instead of the handle. In eitherevent, the end effector 128730 comprises shears configured to transectthe tissue of a patient. The shears comprise two jaws 128740 and 128750configured to transect the patient tissue positioned between the jaws128740 and 128750 as the jaws 128740 and 128750 are being closed. Eachof the jaws 128740 and 128750 comprises a sharp edge configured to cutthe tissue and are pivotably mounted to the shaft 128720 about a pivotjoint 128760. Such an arrangement can comprise bypassing scissorsshears. Other embodiments are envisioned in which one of the jaws 128740and 128750 comprises a knife edge and the other comprises a mandrelagainst the tissue is supported and transected. Such an arrangement cancomprise a knife wedge in which the knife wedge is moved toward themandrel. In at least one embodiment, the jaw comprising the knife edgeis movable and the jaw comprising the mandrel is stationary. The abovebeing said, embodiments are envisioned in which the tissue-engagingedges of one or both of the jaws 128740 and 128750 are not necessarilysharp.

As discussed above, the end effector 128730 comprises two scissor jaws128740 and 128750 movable between an open position and a closed positionto cut the tissue of a patient. The jaw 128740 comprises a sharp distalend 128741 and the jaw 128750 comprises a sharp distal end 128751 whichare configured to snip the tissue of the patient at the mouth 128731 ofthe end effector 128730, for example. That said, other embodiments areenvisioned in which the distal ends 128741 and 128751 are blunt and canbe used to dissect tissue, for example. In any event, the jaws aredriven by a jaw drive system including an electric drive motor, thespeed of which is adjustable to adjust the closure rate and/or openingrate of the jaws. Referring to the graph 128400 of FIG. 848 , thecontrol system of the surgical system is configured to monitor theloading, or shear, force on the jaws 128740 and 128750 as the jaws128740 and 128750 are being closed and adaptively slow down the drivemotor when large forces, or forces above a threshold Fc, are experiencedby the jaws 128740 and 128750. Such large forces often occur when thetissue T being cut by the jaws 128740 and 128750 is thick, for example.Similar to the above, the control system can monitor the current drawnby the drive motor as a proxy for the loading force being experienced bythe jaws 128740 and 128750. In addition to or in lieu of this approach,the control system can be configured to measure the jaw loading forcedirectly by one or more load cells and/or strain gauges, for example.Once the loading force experienced by the jaws 128740 and 128750 dropsbelow the force threshold Fc, the control system can adaptively speed upthe jaw closure rate. Alternatively, the control system can maintain thelower closure rate of the jaws 128740 and 128750 even though the forcethreshold is no longer being exceeded.

The above-provided discussion with respect to the surgical system 128700can provide mechanical energy or a mechanical cutting force to thetissue of a patient. That said, the surgical system 128700 is alsoconfigured to provide electrosurgical energy or an electrosurgicalcutting force to the tissue of a patient. In various instances, theelectrosurgical energy comprises RF energy, for example; however,electrosurgical energy could be supplied to the patient tissue at anysuitable frequency. In addition to or in lieu of AC power, the surgicalsystem 128700 can be configured to supply DC power to the patienttissue. The surgical system 128700 comprises a generator in electricalcommunication with one or more electrical pathways defined in theinstrument shaft 128720 which can supply electrical power to the jaws128740 and 128750 and also provide a return path for the current. In atleast one instance, the jaw 128740 comprises an electrode 128742 inelectrical communication with a first electrical pathway in the shaft128720 and the jaw 128750 comprises an electrode 128752 in electricalcommunication with a second electrical pathway in the shaft 128720. Thefirst and second electrical pathways are electrically insulated, or atleast substantially insulated, from one another and the surroundingshaft structure such that the first and second electrical pathways, theelectrodes 128742 and 128752, and the tissue positioned between theelectrodes 128742 and 128752 forms a circuit. Such an arrangementprovides a bipolar arrangement between the electrodes 128742 and 128752.That said, embodiments are envisioned in which a monopolar arrangementcould be used. In such an arrangement, the return path for the currentgoes through the patient and into a return electrode positioned on orunder the patient, for example.

As discussed above, the tissue of a patient can be cut by using amechanical force and/or an electrical force. Such mechanical andelectrical forces can be applied simultaneously and/or sequentially. Forinstance, both forces can be applied at the beginning of a tissuecutting actuation and then the mechanical force can be discontinued infavor of the electrosurgical force finishing the tissue cuttingactuation. Such an approach can apply an energy-created hemostatic sealto the tissue after the mechanical cutting has been completed. In sucharrangements, the electrosurgical force is applied throughout theduration of the tissue cutting actuation. In other instances, themechanical cutting force, without the electrosurgical cutting force, canbe used to start a tissue cutting actuation which is then followed bythe electrosurgical cutting force after the mechanical cutting force hasbeen stopped. In such arrangements, the mechanical and electrosurgicalforces are not overlapping or co-extensive. In various instances, boththe mechanical and electrosurgical forces are overlapping andco-extensive throughout the entire tissue cutting actuation. In at leastone instance, both forces are overlapping and co-extensive throughoutthe entire tissue cutting actuation but in magnitudes or intensitiesthat change during the tissue cutting actuation. The above being said,any suitable combination, pattern, and/or sequence of mechanical andelectrosurgical cutting forces and energies could be used.

Further to the above, the surgical system 128700 comprises a controlsystem configured to co-ordinate the application of the mechanical forceand electrosurgical energy to the patient tissue. In various instances,the control system is in communication with the motor controller whichdrives the jaws 128740 and 128750 and, also, the electrical generatorand comprises one or more sensing systems for monitoring the mechanicalforce and electrosurgical energy being applied to the tissue. Systemsfor monitoring the forces within a mechanical drive system are disclosedelsewhere herein. Systems for monitoring the electrosurgical energybeing applied to the patient tissue include monitoring the impedance, orchanges in the impedance, of the patient tissue via the electricalpathways of the electrosurgical circuit. In at least one instance,referring to the graph 128800 in FIG. 849 , the RF current/voltage ratioof the electrosurgical power being applied to the patient tissue by thegenerator is evaluated by monitoring the current and voltage of thepower being supplied by the generator. The impedance of the tissue andthe RF current/voltage ratio of the electrosurgical power are a functionof many variables such as the temperature of the tissue, the density ofthe tissue, the thickness of the tissue, the type of tissue between thejaws 128740 and 128750, the duration in which the power is applied tothe tissue, among others, which change throughout the application of theelectrosurgical energy.

Further to the above, the control system and/or generator of thesurgical system 128700 comprises one or more ammeter circuits and/orvoltmeter circuits configured to monitor the electrosurgical currentand/or voltage, respectively, being applied to the patient tissue.Referring again to FIG. 849 , a minimum amplitude limit and/or a maximumamplitude limit on the current being applied to the patient tissue canbe preset in the control system and/or can be controllable by the userof the surgical instrument system through one or more input controls.The minimum and maximum amplitude limits can define a current envelopewithin which the electrosurgical portion of the surgical system 128700is operated.

In various instances, the control system of the surgical system 128700is configured to adaptively increase the electrosurgical energy appliedto the patient tissue when the drive motor slows. The motor slowing canbe a reaction to an increase in the tissue cutting load and/or anadaptation of the control system. Similarly, the control system of thesurgical system 128700 is configured to adaptively increase theelectrosurgical energy applied to the patient tissue when the drivemotor stops. Again, the motor stopping can be a reaction to an increasein the tissue cutting load and/or an adaptation of the control system.Increasing the electrosurgical energy when the electric motor slowsand/or stops can compensate for a reduction in mechanical cuttingenergy. In alternative embodiments, the electrosurgical energy can bereduced and/or stopped when the electric motor slows and/or stops. Suchembodiments can afford the clinician to evaluate the situation in alow-energy environment.

In various instances, the control system of the surgical system 128700is configured to adaptively decrease the electrosurgical energy appliedto the patient tissue when the drive motor speeds up. The motor speedingup can be a reaction to a decrease in the cutting load and/or anadaptation of the control system. Decreasing the electrosurgical energywhen the electric motor slows and/or stops can compensate for, orbalance out, an increase in mechanical cutting energy. In alternativeembodiments, the electrosurgical energy can be increased when theelectric motor speeds up. Such embodiments can accelerate the closure ofthe jaws and provide a clean, quick cutting motion.

In various instances, the control system of the surgical system 128700is configured to adaptively increase the speed of the drive motor whenthe electrosurgical energy applied to the patient tissue decreases. Theelectrosurgical energy decreasing can be a reaction to a change intissue properties and/or an adaptation of the control system. Similarly,the control system of the surgical system 128700 is configured toadaptively increase the speed of the drive motor when electrosurgicalenergy applied to the patient tissue stops in response to an adaptationof the control system. Increasing the speed of the drive motor when theelectrosurgical energy decreases or is stopped can compensate for areduction in electrosurgical cutting energy. In alternative embodiments,the speed of the drive motor can be reduced and/or stopped when theelectrosurgical energy decreases and/or is stopped. Such embodiments canafford the clinician to evaluate the situation in a low-energy and/orstatic environment.

In various instances, the control system of the surgical system 128700is configured to adaptively decrease the speed of the electric motorwhen the electrosurgical energy applied to the patient tissue increases.The electrosurgical energy increasing can be a reaction to a change intissue properties and/or an adaptation of the control system. Decreasingthe drive motor speed when the electrosurgical energy increases cancompensate for, or balance out, an increase in electrosurgical cuttingenergy. In alternative embodiments, the drive motor speed can beincreased when the electrosurgical energy increases. Such embodimentscan accelerate the closure of the jaws and provide a clean, quickcutting motion.

In various instances, the surgical system 128700 comprises controls,such as on the handle of the surgical system 128700, for example, that aclinician can use to control when the mechanical and/or electrosurgicalforces are applied. In addition to or in lieu of manual controls, thecontrol system of the surgical system 128700 is configured to monitorthe mechanical force and electrical energy being applied to the tissueand adjust one or the other, if needed, to cut the tissue in a desirablemanner according to one or more predetermined force-energy curves and/ormatrices. In at least one instance, the control system can increase theelectrical energy being delivered to the tissue once the mechanicalforce being applied reaches a threshold limit. Moreover, the controlsystem is configured to consider other parameters, such as the impedanceof the tissue being cut, when making adjustments to the mechanical forceand/or electrical energy being applied to the tissue.

The surgical instrument systems described herein are motivated by anelectric motor; however, the surgical instrument systems describedherein can be motivated in any suitable manner. In certain instances,the motors disclosed herein may comprise a portion or portions of arobotically controlled system. U.S. patent application Ser. No.13/118,241, entitled SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLEDEPLOYMENT ARRANGEMENTS, now U.S. Pat. No. 9,072,535, for example,discloses several examples of a robotic surgical instrument system ingreater detail, the entire disclosure of which is incorporated byreference herein.

The surgical instrument systems described herein are motivated by anelectric motor; however, the surgical instrument systems describedherein can be motivated in any suitable manner. In certain instances,the motors disclosed herein may comprise a portion or portions of arobotically controlled system. U.S. patent application Ser. No.13/118,241, entitled SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLEDEPLOYMENT ARRANGEMENTS, now U.S. Pat. No. 9,072,535, for example,discloses several examples of a robotic surgical instrument system ingreater detail, the entire disclosure of which is incorporated byreference herein.

The surgical instrument systems described herein can be used inconnection with the deployment and deformation of staples. Variousembodiments are envisioned which deploy fasteners other than staples,such as clamps or tacks, for example. Moreover, various embodiments areenvisioned which utilize any suitable means for sealing tissue. Forinstance, an end effector in accordance with various embodiments cancomprise electrodes configured to heat and seal the tissue. Also, forinstance, an end effector in accordance with certain embodiments canapply vibrational energy to seal the tissue. In addition, variousembodiments are envisioned which utilize a suitable cutting means to cutthe tissue.

The devices, systems, and methods disclosed in the Subject Applicationcan be used with the devices, systems, and methods disclosed in U.S.Provisional Patent Application Ser. No. 62/659,900, entitled METHOD OFHUB COMMUNICATION, filed on Apr. 19, 2018, U.S. Provisional PatentApplication Ser. No. 62/611,341, entitled INTERACTIVE SURGICAL PLATFORM,filed on Dec. 28, 2017, U.S. Provisional Patent Application Ser. No.62/611,340, entitled CLOUD-BASED MEDICAL ANALYTICS, filed on Dec. 28,2017, and U.S. Provisional Patent Application Ser. No. 62/611,339,entitled ROBOT ASSISTED SURGICAL PLATFORM, filed on Dec. 28, 2017, whichare incorporated by reference in their entireties herein. The devices,systems, and methods disclosed in the Subject Application can also beused with the devices, systems, and methods disclosed in U.S. patentapplication Ser. No. 15/908,021, entitled SURGICAL INSTRUMENT WITHREMOTE RELEASE, filed on Feb. 28, 2018, U.S. patent application Ser. No.15/908,012, entitled SURGICAL INSTRUMENT HAVING DUAL ROTATABLE MEMBERSTO EFFECT DIFFERENT TYPES OF END EFFECTOR MOVEMENT, filed on Feb. 28,2018, U.S. patent application Ser. No. 15/908,040, entitled SURGICALINSTRUMENT WITH ROTARY DRIVE SELECTIVELY ACTUATING MULTIPLE END EFFECTORFUNCTIONS, filed on Feb. 28, 2018, U.S. patent application Ser. No.15/908,057, entitled SURGICAL INSTRUMENT WITH ROTARY DRIVE SELECTIVELYACTUATING MULTIPLE END EFFECTOR FUNCTIONS, filed on Feb. 28, 2018, U.S.patent application Ser. No. 15/908,058, entitled SURGICAL INSTRUMENTWITH MODULAR POWER SOURCES, filed on Feb. 28, 2018, and U.S. patentapplication Ser. No. 15/908,143, entitled SURGICAL INSTRUMENT WITHSENSOR AND/OR CONTROL SYSTEMS, filed on Feb. 28, 2018, which areincorporated by reference in their entireties herein. The devices,systems, and methods disclosed in the Subject Application can also beused with the devices, systems, and methods disclosed in U.S. patentapplication Ser. No. 14/226,133, now U.S. Patent Application PublicationNo. 2015/0272557, entitled MODULAR SURGICAL INSTRUMENT SYSTEM, filed onMar. 26, 2014, which is incorporated by reference in its entiretyherein.

The entire disclosures of:

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Although various devices have been described herein in connection withcertain embodiments, modifications and variations to those embodimentsmay be implemented. Particular features, structures, or characteristicsmay be combined in any suitable manner in one or more embodiments. Thus,the particular features, structures, or characteristics illustrated ordescribed in connection with one embodiment may be combined in whole orin part, with the features, structures or characteristics of one oremore other embodiments without limitation. Also, where materials aredisclosed for certain components, other materials may be used.Furthermore, according to various embodiments, a single component may bereplaced by multiple components, and multiple components may be replacedby a single component, to perform a given function or functions. Theforegoing description and following claims are intended to cover allsuch modification and variations.

The devices disclosed herein can be designed to be disposed of after asingle use, or they can be designed to be used multiple times. In eithercase, however, a device can be reconditioned for reuse after at leastone use. Reconditioning can include any combination of the stepsincluding, but not limited to, the disassembly of the device, followedby cleaning or replacement of particular pieces of the device, andsubsequent reassembly of the device. In particular, a reconditioningfacility and/or surgical team can disassemble a device and, aftercleaning and/or replacing particular parts of the device, the device canbe reassembled for subsequent use. Those skilled in the art willappreciate that reconditioning of a device can utilize a variety oftechniques for disassembly, cleaning/replacement, and reassembly. Use ofsuch techniques, and the resulting reconditioned device, are all withinthe scope of the present application.

The devices disclosed herein may be processed before surgery. First, anew or used instrument may be obtained and, when necessary, cleaned. Theinstrument may then be sterilized. In one sterilization technique, theinstrument is placed in a closed and sealed container, such as a plasticor TYVEK bag. The container and instrument may then be placed in a fieldof radiation that can penetrate the container, such as gamma radiation,x-rays, and/or high-energy electrons. The radiation may kill bacteria onthe instrument and in the container. The sterilized instrument may thenbe stored in the sterile container. The sealed container may keep theinstrument sterile until it is opened in a medical facility. A devicemay also be sterilized using any other technique known in the art,including but not limited to beta radiation, gamma radiation, ethyleneoxide, plasma peroxide, and/or steam.

While several forms have been illustrated and described, it is not theintention of the applicant to restrict or limit the scope of theappended claims to such detail. Numerous modifications, variations,changes, substitutions, combinations, and equivalents to those forms maybe implemented and will occur to those skilled in the art withoutdeparting from the scope of the present disclosure. Moreover, thestructure of each element associated with the described forms can bealternatively described as a means for providing the function performedby the element. Also, where materials are disclosed for certaincomponents, other materials may be used. It is therefore to beunderstood that the foregoing description and the appended claims areintended to cover all such modifications, combinations, and variationsas falling within the scope of the disclosed forms. The appended claimsare intended to cover all such modifications, variations, changes,substitutions, modifications, and equivalents.

The foregoing detailed description has set forth various forms of thedevices and/or processes via the use of block diagrams, flowcharts,and/or examples. Insofar as such block diagrams, flowcharts, and/orexamples contain one or more functions and/or operations, it will beunderstood by those within the art that each function and/or operationwithin such block diagrams, flowcharts, and/or examples can beimplemented, individually and/or collectively, by a wide range ofhardware, software, firmware, or virtually any combination thereof.Those skilled in the art will recognize that some aspects of the formsdisclosed herein, in whole or in part, can be equivalently implementedin integrated circuits, as one or more computer programs running on oneor more computers (e.g., as one or more programs running on one or morecomputer systems), as one or more programs running on one or moreprocessors (e.g., as one or more programs running on one or moremicroprocessors), as firmware, or as virtually any combination thereof,and that designing the circuitry and/or writing the code for thesoftware and or firmware would be well within the skill of one ofskilled in the art in light of this disclosure. In addition, thoseskilled in the art will appreciate that the mechanisms of the subjectmatter described herein are capable of being distributed as one or moreprogram products in a variety of forms and that an illustrative form ofthe subject matter described herein applies regardless of the particulartype of signal-bearing medium used to actually carry out thedistribution.

Instructions used to program logic to perform various disclosed aspectscan be stored within a memory in the system, such as DRAM, cache, flashmemory, or other storage. Furthermore, the instructions can bedistributed via a network or by way of other computer-readable media.Thus a machine-readable medium may include any mechanism for storing ortransmitting information in a form readable by a machine (e.g., acomputer), but is not limited to, floppy diskettes, optical disks,CD-ROMs, magneto-optical disks, ROM, RAM, EPROM, EEPROM, magnetic oroptical cards, flash memory, or tangible, machine-readable storage usedin the transmission of information over the Internet via electrical,optical, acoustical, or other forms of propagated signals (e.g., carrierwaves, infrared signals, digital signals). Accordingly, thenon-transitory computer-readable medium includes any type of tangiblemachine-readable medium suitable for storing or transmitting electronicinstructions or information in a form readable by a machine (e.g., acomputer).

As used in any aspect herein, the term “control circuit” may refer to,for example, hardwired circuitry, programmable circuitry (e.g., acomputer processor comprising one or more individual instructionprocessing cores, processing unit, processor, microcontroller,microcontroller unit, controller, DSP, PLD, programmable logic array(PLA), or FPGA), state machine circuitry, firmware that storesinstructions executed by programmable circuitry, and any combinationthereof. The control circuit may, collectively or individually, beembodied as circuitry that forms part of a larger system, for example,an integrated circuit, an application-specific integrated circuit(ASIC), a system on-chip (SoC), desktop computers, laptop computers,tablet computers, servers, smart phones, etc. Accordingly, as usedherein, “control circuit” includes, but is not limited to, electricalcircuitry having at least one discrete electrical circuit, electricalcircuitry having at least one integrated circuit, electrical circuitryhaving at least one application-specific integrated circuit, electricalcircuitry forming a general-purpose computing device configured by acomputer program (e.g., a general-purpose computer configured by acomputer program which at least partially carries out processes and/ordevices described herein, or a microprocessor configured by a computerprogram which at least partially carries out processes and/or devicesdescribed herein), electrical circuitry forming a memory device (e.g.,forms of random access memory), and/or electrical circuitry forming acommunications device (e.g., a modem, communications switch, oroptical-electrical equipment). Those having skill in the art willrecognize that the subject matter described herein may be implemented inan analog or digital fashion or some combination thereof.

As used in any aspect herein, the term “logic” may refer to an app,software, firmware, and/or circuitry configured to perform any of theaforementioned operations. Software may be embodied as a softwarepackage, code, instructions, instruction sets, and/or data recorded onnon-transitory computer-readable storage medium. Firmware may beembodied as code, instructions, instruction sets, and/or data that arehard-coded (e.g., non-volatile) in memory devices.

As used in any aspect herein, the terms “component,” “system,” “module,”and the like can refer to a computer-related entity, either hardware, acombination of hardware and software, software, or software inexecution.

As used in any aspect herein, an “algorithm” refers to a self-consistentsequence of steps leading to a desired result, where a “step” refers toa manipulation of physical quantities and/or logic states which may,though need not necessarily, take the form of electrical or magneticsignals capable of being stored, transferred, combined, compared, andotherwise manipulated. It is common usage to refer to these signals asbits, values, elements, symbols, characters, terms, numbers, or thelike. These and similar terms may be associated with the appropriatephysical quantities and are merely convenient labels applied to thesequantities and/or states.

A network may include a packet-switched network. The communicationdevices may be capable of communicating with each other using a selectedpacket-switched network communications protocol. One examplecommunications protocol may include an Ethernet communications protocolwhich may be capable permitting communication using a TransmissionControl Protocol/IP. The Ethernet protocol may comply or be compatiblewith the Ethernet standard published by the Institute of Electrical andElectronics Engineers (IEEE) entitled “IEEE 802.3 Standard,” publishedin December 2008 and/or later versions of this standard. Alternativelyor additionally, the communication devices may be capable ofcommunicating with each other using an X.25 communications protocol. TheX.25 communications protocol may comply or be compatible with a standardpromulgated by the International TelecommunicationUnion-Telecommunication Standardization Sector (ITU-T). Alternatively oradditionally, the communication devices may be capable of communicatingwith each other using a frame relay communications protocol. The framerelay communications protocol may comply or be compatible with astandard promulgated by Consultative Committee for InternationalTelegraph and Telephone (CCITT) and/or the American National StandardsInstitute (ANSI). Alternatively or additionally, the transceivers may becapable of communicating with each other using an Asynchronous TransferMode (ATM) communications protocol. The ATM communications protocol maycomply or be compatible with an ATM standard published by the ATM Forum,entitled “ATM-MPLS Network Interworking 2.0,” published August 2001,and/or later versions of this standard. Of course, different and/orafter-developed connection-oriented network communication protocols areequally contemplated herein.

Unless specifically stated otherwise as apparent from the foregoingdisclosure, it is appreciated that, throughout the foregoing disclosure,discussions using terms such as “processing,” “computing,”“calculating,” “determining,” “displaying,” or the like, refer to theaction and processes of a computer system, or similar electroniccomputing device, that manipulates and transforms data represented asphysical (electronic) quantities within the computer system's registersand memories into other data similarly represented as physicalquantities within the computer system memories or registers or othersuch information storage, transmission, or display devices.

One or more components may be referred to herein as “configured to,”“configurable to,” “operable/operative to,” “adapted/adaptable,” “ableto,” “conformable/conformed to,” etc. Those skilled in the art willrecognize that “configured to” can generally encompass active-statecomponents, inactive-state components, and/or standby-state components,unless context requires otherwise.

With respect to the appended claims, those skilled in the art willappreciate that recited operations therein may generally be performed inany order. Also, although various operational flow diagrams arepresented in a sequence(s), it should be understood that the variousoperations may be performed in other orders than those which areillustrated or may be performed concurrently. Examples of such alternateorderings may include overlapping, interleaved, interrupted, reordered,incremental, preparatory, supplemental, simultaneous, reverse, or othervariant orderings, unless context dictates otherwise. Furthermore, termslike “responsive to,” “related to,” or other past-tense adjectives aregenerally not intended to exclude such variants, unless context dictatesotherwise.

It is worthy to note that any reference to “one aspect,” “an aspect,”“an exemplification,” “one exemplification,” and the like means that aparticular feature, structure, or characteristic described in connectionwith the aspect is included in at least one aspect. Thus, appearances ofthe phrases “in one aspect,” “in an aspect,” “in an exemplification,”and “in one exemplification” in various places throughout thespecification are not necessarily all referring to the same aspect.Furthermore, the particular features, structures, or characteristics maybe combined in any suitable manner in one or more aspects.

While this invention has been described as having exemplary designs, thepresent invention may be further modified within the spirit and scope ofthe disclosure. This application is therefore intended to cover anyvariations, uses, or adaptations of the invention using its generalprinciples.

Any patent, publication, or other disclosure material, in whole or inpart, that is said to be incorporated by reference herein isincorporated herein only to the extent that the incorporated materialsdo not conflict with existing definitions, statements, or otherdisclosure material set forth in this disclosure. As such, and to theextent necessary, the disclosure as explicitly set forth hereinsupersedes any conflicting material incorporated herein by reference.Any material, or portion thereof, that is said to be incorporated byreference herein, but which conflicts with existing definitions,statements, or other disclosure material set forth herein will only beincorporated to the extent that no conflict arises between thatincorporated material and the existing disclosure material.

1. A method for adjusting the operation of a surgical grasper using machine learning in a surgical suite, wherein said method comprises: gathering data during surgical procedures, wherein the surgical procedures include the use of a surgical grasper comprising jaws movable through a closure stroke; analyzing the gathered data to determine an appropriate operational adjustment of the surgical grasper; and adjusting the operation of the surgical grasper to improve the operation of the surgical grasper.
 2. The method of claim 1, wherein gathering data comprises storing data in a surgical hub.
 3. The method of claim 1, wherein the surgical grasper is attached to a surgical robot and is configured to be operated manually by a clinician.
 4. The method of claim 1, wherein adjusting the operation of the surgical grasper comprises adjusting the final tissue gap between the jaws.
 5. The method of claim 1, wherein adjusting the operation of the surgical grasper comprises adjusting the speed of the jaws.
 6. The method of claim 1, wherein gathering data comprises monitoring the movement of the jaws during use of the surgical grasper using a force detection circuit.
 7. The method of claim 1, wherein adjusting the operation of the surgical grasper comprises placing a power control program of a surgical robot to which the surgical grasper is attached in a limp mode.
 8. The method of claim 1, wherein gathering data comprises accessing existing information based on previous operations.
 9. A method for adjusting the operation of a surgical dissector using machine learning in a surgical suite, wherein said method comprises: gathering data during surgical procedures, wherein the surgical procedures include the use of a surgical dissector comprising jaws movable through an opening stroke; analyzing the gathered data to determine an appropriate operational adjustment of the surgical dissector; and adjusting the operation of the surgical dissector to improve the operation of the surgical dissector.
 10. The method of claim 9, wherein gathering data comprises storing data in a surgical hub.
 11. The method of claim 9, wherein adjusting the operation of the surgical dissector comprises adjusting the final open distance between the jaws.
 12. The method of claim 9, wherein adjusting the operation of the surgical dissector comprises adjusting the speed of the jaws.
 13. The method of claim 9, wherein gathering data comprises monitoring the movement of the jaws during use of the surgical dissector using a force detection circuit.
 14. The method of claim 1, wherein gathering data comprises accessing existing information based on previous operations.
 15. A method for adjusting the operation of a surgical instrument using machine learning in a surgical suite, wherein said method comprises: gathering data during surgical procedures, wherein the surgical procedures include the use of a surgical instrument assembled from modules selected from a set of modules; analyzing the gathered data and the selected modules to determine an appropriate operational adjustment of the surgical instrument; and adjusting the operation of the surgical instrument to improve the operation of the surgical instrument.
 16. The method of claim 15, wherein the set of modules comprises a first module, a second module, and a third module.
 17. The method of claim 16, wherein the first module comprises a drive system, wherein the drive system comprises an operational threshold, and wherein adjusting the operation of the surgical instrument comprises lowering the operational threshold when the second module is used in the surgical instrument.
 18. The method of claim 17, wherein the operational threshold comprises a maximum current limit.
 19. The method of claim 17, wherein the operational threshold comprises a maximum force limit.
 20. The method of claim 17, wherein the operational threshold comprises a maximum strain limit. 21-28. (canceled) 